A New Era of Affordable Quality Employer Healthcare Choices
Ensurian is pioneering new and innovative self-funded healthcare plans to put the power of choice back into the hands of employers, employees and their families. The nationwide self-insured employer programs we design improve employee participation by providing access to affordable, high-quality health plan choices that meet a wide variety of needs and budgets.
Self-funded and level-funded Minimum Value Plans (MVP) and Minimum Essential Coverage (MEC) plans can stand alone or be combined to give employers the flexibility and the services you’d expect in a new era of healthcare.
What is self funding?
Employers are self funded when they absorb the costs of their group’s healthcare claims instead of paying high premiums to commercial insurers for the administration and risk of one-size-fits-all group insurance plans. One big advantage of self funding is that employers only pay for the healthcare services their groups actually use. Plus, it gives them the freedom to customize plans to the unique needs and budgets of their employees. There are two types of self-insured plans: self funded and level funded.
How do Ensurian’s self-funded and level-funded group plan designs work?
Ensurian helps employers take control of their group healthcare costs and benefits by building in a combination of value-added services. Ensuian builds a secure foundation by aligning with companies that:
- Handle the administration of group benefits and the distribution of employee and corporate contributions on behalf of the employer
- Use a captive affiliate to customize cost-effective risk ratio programs for each employer group
- Provide both specific and aggregate stop-loss accommodations to help protect employers from catastrophic claims that exceed the predetermined coverage levels of their group plans
What is the difference between self-funded and level-funded healthcare plans?
With self-funded plans, employers operate their own health plans instead of purchasing fully-insured plans from insurance carriers. This lowers overall employee costs, increases participation and allows them to save the profit margin that insurance companies add to premiums for administering plans. There is more risk involved with self-funding. Claims still have to be paid even if there are more than expected. However, Aliera provides additional protections that help anticipate and lower risks so employer potential for premium ROI remains significant.
Level-funded plans are less risky and provide employers a streamlined and supportive transition from fully-insured plans to self-funded platforms. Employers still save money and improve potential for premium ROI, but they are not liable for more than the cost of employee premiums. With a level-funded plan, the maximum exposure for employers is equal to the amount of the premium (similar to a traditional fully-insured plan, but at a lower cost). Additionally, if anticipated spends are not used during the plan year, employers could receive a portion of the premium back—saving significant money and adding dollars directly to the bottom line.
Ensurian coordinates the following value-added services to help employers reduce risk and achieve all the benefits our self-funded group plans were designed to offer:
- Customizable health plans for the unique needs of your employees and your business
- Multiple stop-loss options with specific and aggregate accommodations – A+ rated Gerber Life
- Experience rated, flexible underwriting
- Multiple network options – Cigna, First Health, MultiPlan PHCS and Reference Based Pricing (RBP) with ClaimDoc or ELAP
- Complete TPA services with real-time reporting, data analysis, wellness, billing, eligibility, case management
- Free telemedicine
- Flexible PBM including: Express Scripts, Optum, CVS/Caremark, ProCare Rx