What is Level Funding?
Level funding is an innovative healthcare financing option that combines elements of self-insurance with the predictability of traditional fully insured plans. It’s designed for small to medium-sized businesses looking to gain more control over their healthcare costs without taking on excessive risk or administrative burden.
How Level Funding Works
1. Fixed Monthly Payments:
- Companies pay a set amount each month, similar to a traditional insurance premium.
- This amount is calculated based on expected claims, stop-loss insurance, and administrative fees.
- Payments remain consistent throughout the year, providing budget stability.
2. Stop-Loss Insurance:
- To protect against unexpectedly high claims, stop-loss insurance is included.
- This coverage kicks in if individual or aggregate claims exceed predetermined thresholds.
3. Administrative Services:
- NARFA handles all paperwork and claim processing.
- This includes employee enrollment, claims adjudication, and all member service.
4. Network Access:
- Employees gain access to a broad network of healthcare providers with the Cigna National PPO Network.
5. Reporting and Analysis:
- Employers receive detailed reports on healthcare spending and utilization.
- This data can be used to make informed decisions about future plan designs.
Advantages for Employers
1. Cost Control:
- Potential for significant savings.
2. Customization:
- Ability to tailor plan designs to meet the specific needs of your workforce.
- Flexibility to adjust coverage options and contribution strategies.
3. Transparency:
- Detailed reporting provides insight into healthcare spending patterns.
- Better understanding of what drives costs in your health plan.
4. Predictable Budgeting:
- Fixed monthly payments allow for easier financial planning.
- Protection against unexpected high claims through stop-loss insurance.
5. Reduced Administrative Burden:
- NARFA handles day-to-day plan management.
- Employers can focus on their core business rather than healthcare logistics.
6. Potential Tax Advantages:
- Consult with a tax professional for specific guidance.
Advantages for Employees
1. Continuity of Care:
- Employees can typically keep their existing doctors and healthcare providers.
- No disruption to ongoing treatments or established medical relationships.
2. Broad Network Access:
- Access to a large network of healthcare providers (e.g., Cigna National PPO Network).
- Freedom to choose preferred doctors and hospitals.
3. Stable Coverage:
- From the employee’s perspective, the plan functions like traditional insurance.
- No change in how they access care or use their benefits.
4. Potential for Enhanced Benefits:
- Surplus to be used to offset future premium increases.
- Possibility of more tailored coverage options that meet specific workforce needs.
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Example 1: Surplus to Offset Future Premium Increases
Auto Repair Shop (5 Employees)
Traditional Plan | $57,600/year |
Level funded | $48,385/year |
Potential Savings | $9,215/year |
Example 2: Stop Loss Kicks In with Higher Than Expected Claims
Fuel Distributor (10 employees)
Traditional Plan | $208,800/year |
Projected Claims | $146,160/year |
Actual Claims | $167,040 |
Administration | $62,640 |
Stop Loss Covers | $20,880 |
Example 3: Break Even Scenario
Automotive Dealership (40 employees)
Traditional Plan | $684,000/year |
Level funded | $576,560/year |
Claims | $402,192 |
Administration | $172,368 |
Any surplus is utilized to offset future premium increases and healthcare costs
Is Level Funding Right for Your Business?
Level funding may be an excellent option if your company:
Next Steps to Implement Level Funding
Please contact your NARFA Trust Representative for a personalized analysis, and discussion of your company needs. NARFA will turn around a recommendation and quote quickly.
By choosing level funding, businesses can gain the advantages of self-insurance—such as cost control and customization—while maintaining the simplicity and predictability of a fully insured plan. It’s a modern approach to healthcare financing that can lead to significant savings and improved benefits for both employers and employees.