Claim Fund - Oberlin Marketing

Allied™ Funding Advantage
How Alternative Funding Works
Why Funding Advantage?
Do your group health clients want to
receive a refund for being healthy?
Alternative Funding is the answer!
Fully Insured or Self Insured?
 Fully Insured
 Risk Bearer is the Insurance Company
 Premium covers all risks and costs
 Self Insured
 Risk Bearer is the Employer
 Claims are paid from Employer funds
 Employer pays for claims administration
Alternative Funding
 Also called Partial Self-Funding
 Employer is still the risk bearer
 Employer purchases Stop Loss
Insurance to protect against
high claims
Stop Loss Insurance
Employer’s risk minimized
 Specific Stop Loss
 Claims paid by carrier when an individual’s claims exceed a set dollar
 Aggregate Stop Loss
 Claims paid by carrier when the group’s total claims exceed a set
dollar amount
Why Consider Self Funding Sales?
 55% of all companies are fully or
partially self funded
 Only 13% of employers with 200 or
less employees are self or partially
 Staying Power
 Employers that self fund remain doing
so on average of 3 to 5 years
 Opportunity
 Market is untapped for small group
 Savings
 Chance for employers to save and take
control of their health plan
What is Allied Funding Advantage?
 An alternative funding plan for groups of 10 to 99
 Limits employer risk from self-funding
 Allows employer to save significant dollars
 Monthly costs may be less than fully-insured premiums
 Potential for refunds at end of plan year
The only risk is not getting a
refund at the end of the year!
How Does it Work?
 Monthly Costs
 Employer makes monthly contributions for each of these
three items:
Funding Advantage Monthly Costs
 Admin & Sales
 Allied claims paying and reporting expenses
 Agent & General Agent Sales Compensation
 Stop Loss Insurance
 Covers both Specific and
Aggregate Coverage
 Costs vary with plan benefits
 Funding Advantage has set
levels for Specific & Aggregate
to keep sales process simple
Funding Advantage Monthly Costs
 Claim Fund – Employer’s Money
 Employer contributions used to
fund expected claim costs
 MAX funded plan
 Employers’ MAXIMUM claim
costs for the year
 Monthly contributions are 1/12 of
this annual cost each month
 MAX funded - Employer will
NEVER be charged more than
this for claims
 Claims Fund money left over is
the employers!
Funding Advantage Monthly Costs
 Claim Fund Questions
 Accommodation
 When claims exceed money in claim fund –
Insurer loans employer money
 Reporting
 Detailed monthly reporting showing claim
fund activity
 Plan Year and Claims Run Out
 Plan year is 12 months
 Claims incurred during plan year are payable
for 9 months past end of plan year
 At end of the 9-month run-out – all remaining
claims funds belong to employer!
 No hidden terminal liability costs
 ERISA plan is the plan of benefits for
the employee
 Funding Advantage Options
 Premium Advantage Plans
 Traditional PPO
 HSA Qualified Plans
 Indemnity Freedom Plans
 No networks – no penalties
 True freedom of provider choice
 No balance billing
Allied Funding Advantage
 Advantages for Employer
Limits the risk of self funding
Lowers monthly costs
Healthy groups can receive LARGE refunds
Won’t be subject to the ObamaCare “rate
shocks” that will happen in 2014
Allied Funding Advantage
 Advantages For Agents
 Available for small groups 10 to 99
 Not subject to MLR regulations
 No restrictions on Compensation!
 Compensation paid on full monthly costs.
 Take advantage of group trend toward
self-funding with a simple, flexible plan
Phone: (888) 767-7133
Fax: (913) 945-4396
Quote E-mail:
[email protected]
Web site:
The RIGHT Benefits. The RIGHT Price.
Related flashcards
Create Flashcards