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Self-funded Medical

Health

 

As the cost of healthcare continues to escalate, more and more brokers are looking for alternative solutions for their clients. A Self-funded solution is a powerful and practical alternative to traditional insurance.  Amwins Connect Administrators presents HealthyAdvantage! Give your employer clients the ability to directly fund their actual claim costs while limiting their risk with the purchase of stop-loss insurance.

With a traditional fully insured plan, the insurance company pays for most of the benefits and offers members small out of pocket expenses in the form of deductibles, copays and coinsurance but keeps the profits when the claims are lower than expected. With HealthyAdvantage, the employer pays the benefits up to a higher deductible, but purchases stop-loss insurance to reimburse the plan if the deductible is met.

Stop-loss insurance protects the plan against individual catastrophic claims (specific stop-loss) or their total claim expenses (aggregate stop-loss) exceeding their annual budget. Employers hire TPAs such as Amwins Connect Administrators to process, manage, and pay the claims on behalf of the employer.

HealthyAdvantage is a Level Funded Health Plan. Level Funded Health plans allow employers to pay a preset level premium equivalent which includes fixed costs and maximum claims fund. Because the employer is pre-paying the claims, 100% of the unused funds at the end of the contract period will be returned to the employer as savings!

With this funding arrangement, clients get the benefit of an unbundled approach to assembling a health plan. Help your employers contain costs by paying claims directly to the providers while allowing the client to customize the benefit design. HealthyAdvantage rewards your clients for good claims experience in a way that makes sense for them.

Click here to review the HealthyAdvantage Broker Product Guide.

Marketing & Guides

Financing Healthcare
Underwriting Grid
Member ID Card Guide
Aggregate Report Definitions
Broker Guide
Data Sheet and Timeline

Underwriting

Group Rx UW Process
Employer Supplemental Questionnaire
Simplified Underwriting - Employee IRX
IRX Dependent Level Census
IRX Explanation

Benefit Summaries

ACA HA PPO 250 100
ACA HA PPO 500 80
ACA HA PPO 1000 70
ACA HA PPO 1500 70
ACA HA PPO 2000 100
ACA HA PPO 2500 80
ACA HA PPO 3000 70
ACA HA PPO 3000 80
ACA HA PPO 3000 100 (HealthySolutions)
ACA HA PPO 3500 80
ACA HA PPO 4000 80
ACA HA PPO 5000 100
ACA HA PPO 7000 100
ACA HA QHDHP 1500 100
ACA HA QHDHP 2700 80
ACA HA QHDHP 2700 100
ACA HA QHDHP 3500 100
ACA HA QHDHP 4000 70
ACA HA QHDHP 5000 100
ACA MEC Only Benefits

 

Harvard Pilgrim Self-Funding
Plans designed for mid-sized employers; More Control, More Flexibility & More Savings   

Group Application
Census
Quote Checklist

 

Anthem Balanced Funding
Delivering control, predictability, savings potential and flexibility.  

Product Details

 

Amwins Resources
We empower you and your clients by partnering with other Amwins operating companies.   

Amwins Connect Administrators
Efficient administration, advanced technology, cost containment strategies and creative benefit designs.

Stealth Partner Group
Unmatched stop loss expertise, access to the industry's top-rated stop loss carriers and highly competitive premium rates.

WebTPA
Independent, nationally licensed provider of infrastructure and service solutions, specializing in customized healthcare benefits administration.


 

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