Level-Funded Group Medical

Small Group Level-Funded Medical plans are different than fully insured Small Group Medical plans. The main difference is Level-Funded Medical plans are exempt from many requirements in the Affordable Care Act (ACA). The most often utilized exemption is that most Level-Funded Medical plans ARE medically underwritten at the employee level (for groups starting at two lives). Secondly, in most cases, they are excluded from the 10 Essential Health Benefits requirements of the ACA. Combining the ability to medically underwrite and allowing carriers flexibility in their contract definitions can equate to substantial premium savings. The final differentiator for Level-Funded Medical contracts is the opportunity to share in your risk. Since the contract is a max funded contract (assuming a worst case claims scenario) if your group performs better than expected, they may be entitled to a premium refund or credit. We can help you indentify which clients would benefit from enrolling in a Level-Funded Medical plan and which clients would be better off with a Fully Insured Medical plan. Please explore the Level-Funded Medical section and then contact us to get started.