The Rise of Level Funded Health Plans

Health care jargon explained
Health insurance 101
Health plans
Healthcare industry

Introduction to Level Funded Health Plans

In the ever-evolving landscape of health insurance, one trend that has been steadily gaining momentum is the growth of Level Funded Health Plans. This innovative approach to employee healthcare benefits has become a viable middle ground between fully insured and self-funded insurance plans, offering businesses a flexible and cost-effective solution. According to the Kaiser Family Foundation (KFF), the percentage of small employers on level funded health plans has increased from 13% in 2020 to ~40% today.

What is Level Funding?

To understand the surge in popularity of Level Funded Health Plans, it's essential to grasp what level funding entails. Unlike traditional fully insured plans where a company pays a fixed premium to an insurance carrier, or self-funded plans where a company assumes all financial risk, level funding strikes a balance.

Level funded health plans involve setting a predetermined monthly premium for each employee's healthcare coverage. This premium covers the cost of healthcare services, administrative fees, and stop-loss insurance. The critical difference lies in the financial predictability it offers.

Examine the Structure and Functionality of Level Funded Health Plans

Level funded plans are typically administered by a Third-Party Administrator (TPA). These TPAs handle the day-to-day administrative tasks, such as claims processing, while the employer retains a greater degree of control over the plan's design and funding.

Level funded plans also include a stop-loss provision, which protects the employer from excessive claims costs. Once claims exceed a certain threshold, the stop-loss insurance kicks in, ensuring that the employer's financial exposure remains manageable.

Exploring the Reasons behind Level Funded Health Plan Growth

Analyzing the Surge in Popularity

The growth of Level Funded Health Plans can be attributed to several factors. One primary driver is the cost-saving potential. These plans offer businesses an opportunity to reduce healthcare expenses while maintaining a high level of coverage for employees. Smaller companies, in particular, find this option attractive as it allows them to compete with larger enterprises in providing competitive employee benefits.

Economic Viability and Benefits

For both employers and employees, level funded health plans have proven to be economically advantageous. Employers benefit from cost predictability, as monthly premiums remain stable, even in the face of fluctuating healthcare utilization. Additionally, the potential for refunds of unused premiums can be a significant incentive.

Employees, on the other hand, enjoy the same level of healthcare benefits as they would under traditional fully insured plans, with the added benefit of greater flexibility in choosing healthcare providers. This allows employees to have more control over their healthcare decisions.

Larger Groups Switching to Level Funded Plans

The trend of large corporations opting for Level Funded Health Plans over traditional options is also on the rise. These companies recognize the financial benefits and flexibility that level funding offers, making it an attractive choice for managing the healthcare needs of a large and diverse workforce.

Comparative Analysis: Level Funded vs Self Funded

To better understand why more organizations are gravitating towards Level Funded Health Plans, it's essential to compare them to self-funded plans.

Advantages of Level Funded Health Plans

  1. Predictability: One of the key advantages of level funding is its predictability. Employers know exactly how much they will pay each month, making budgeting more manageable.
  2. Risk Mitigation: The inclusion of stop-loss insurance provides protection against catastrophic claims, reducing the financial risk for employers.
  3. Refunds: If claims are lower than expected, employers may receive refunds on unused premiums, offering potential cost savings.
  4. Administrative Ease: TPAs handle the day-to-day administration, reducing the administrative burden on employers.

Advantages of Self-Funded Health Plans

  1. Customization: Self-funded plans allow for greater customization of benefits, catering to the specific needs of the workforce.
  2. Cost Control: Employers have more control over healthcare expenses and can implement cost-saving measures directly.
  3. Data Access: Self-funded plans provide access to claims data, enabling employers to identify trends and make informed decisions.

Why More Organizations Choose Level Funded Plans

While self-funded plans offer greater customization, level funded plans strike a balance between cost predictability and customization. The financial safety net provided by stop-loss insurance and the potential for premium refunds make them an attractive option for many organizations.

Case Studies: Success of Level Funded Plans

Let's take a look at a few real-world examples of businesses that have made the switch to Level Funded Health Plans and the impact it had on their employees and financial health.

[Case Study 1]: XYZ Company

XYZ Company, a medium-sized tech firm, transitioned to a level funded health plan. Within the first year, they saw a 15% reduction in healthcare costs while maintaining the same level of coverage for their employees. The financial predictability of level funding allowed them to allocate resources more efficiently.

[Case Study 2]: ABC Manufacturing

ABC Manufacturing, a large industrial company, adopted a level funded plan for its workforce of thousands. The cost savings realized through level funding allowed them to reinvest in employee wellness programs, resulting in improved overall employee health and productivity.

Future Trends in Health Insurance

As Level Funded Health Plans continue to grow in popularity, it's worth considering their future trajectory and potential influence on the wider health insurance sector.

Predicted Growth

The growth of level funded plans is expected to continue, with more businesses recognizing the benefits of this approach. Smaller companies seeking to provide competitive benefits and larger corporations aiming to manage costs more effectively are likely to drive this growth.

Potential Drawbacks and Limits

While level funded plans offer numerous advantages, they may not be suitable for every organization. Businesses with very low employee numbers may not experience the same cost-saving benefits as larger companies. Additionally, changes in healthcare regulations, such as modifications to the Affordable Care Act (ACA), could impact the viability of level funding.

Influential Factors for Future Growth

Several external factors could influence the future growth of Level Funded Health Plans. These factors include:

  1. Legal Changes: Ongoing changes in healthcare legislation can affect the regulatory environment for level funded plans.
  2. Healthcare Costs: Fluctuations in healthcare costs and the overall cost of medical services can impact the attractiveness of level funding as a cost-saving option.
  3. Economic Conditions: Economic conditions, such as recessions or economic booms, can influence businesses' decisions regarding their employee benefit plans.

Answering the Top Questions

1. What are the advantages of level funded health plans?

Level funded health plans offer several advantages, including cost predictability, risk mitigation through stop-loss insurance, potential premium refunds, and reduced administrative burden through third-party administrators (TPAs). Employees benefit from stable premiums, access to a wide range of healthcare providers, and the potential for cost savings.

3. What is level funding in a budget?

Level funding in a budget refers to setting a fixed, consistent allocation of funds for a specific purpose, such as employee healthcare benefits. In the context of level funded health plans, it involves allocating a predetermined monthly premium to cover healthcare expenses and administrative costs.

4. What is level funded vs fully insured?

Level funded health plans are a middle-ground option between fully insured and self-funded plans. In level funded plans, employers pay a fixed monthly premium that covers healthcare costs and administrative fees, with the addition of stop-loss insurance. Fully insured plans involve paying a fixed premium to an insurance carrier, while self-funded plans involve assuming all financial risk for healthcare expenses.

5. How do level funded plans work?

Level funded health plans work by setting a fixed monthly premium for each employee's healthcare coverage. This premium covers healthcare services, administrative fees, and includes stop-loss insurance. Third-party administrators (TPAs) manage the day-to-day administration of the plan, while employers benefit from cost predictability and risk mitigation.

6. Are level funded plans good or bad?

Level funded plans are neither inherently good nor bad; their suitability depends on the specific needs and circumstances of the organization. They can be advantageous for many businesses due to their cost predictability and potential cost savings. However, the appropriateness of level funding should be evaluated on a case-by-case basis.

7. Are level funded plans subject to ACA?

Yes, level funded health plans are subject to certain provisions of the Affordable Care Act (ACA). They must comply with ACA regulations, such as offering essential health benefits and meeting minimum value and affordability standards. However, level funded plans also offer more flexibility in plan design compared to fully insured plans.

9. What is graded funding vs level funding?

Graded funding is a term that typically refers to a type of premium structure in insurance where premiums increase over time based on factors such as age or risk. In contrast, level funding involves setting a consistent, fixed premium for each employee's healthcare coverage.

10. What does it mean when a company is self-funded?

When a company is self-funded, it means that the company assumes the financial risk for its employees' healthcare expenses rather than purchasing a fully insured plan from an insurance carrier. Self-funded companies typically have more control over their healthcare benefits and may use third-party administrators (TPAs) to manage claims and administrative tasks.

Welcome to Decent: a new kind of health plan.

Join our monthly newsletter to stay in the know!


More posts