Level Funding (Partial Self Funding) For Groups Down to 5 Employees

AnnaW

New Member
15
We have Aetna, NGBS in my market. Humana and Allsavers are 10+. Would like some options for 5+ employee groups with stop loss carriers/TPA's to look at.

Thanks
 
Starmark (Trustmark) claims they can go down to 5, but I'd be really apprehensive about going self-funded (ok, partially self-funded) with a group that small even if it is level funded. They're in most states, but not all. You'd have to check with them.
 
Starmark (Trustmark) claims they can go down to 5, but I'd be really apprehensive about going self-funded (ok, partially self-funded) with a group that small even if it is level funded. They're in most states, but not all. You'd have to check with them.

Would be interested in knowing why you are hesitant. At what size group would you be comfortable with level funding? Thanks
 
Depends on the group. But a group that size has to really convince me that they're financially stable enough and understand the commitment to going level-funded. It's really not so much the concentration of risk over so few lives as long as their contract protects them from shortages at the end of the contract period. They can always revert back to fully insured if their claims are too high. My chief concern is them dropping the plan mid-year (financial hardship, business closure, or just plain flakiness, etc.) and retroactively voiding their stop-loss, which is the way the Starmark contracts work.
 
I'm confused on this. Please help me understand. Partial or Level funded has no downside. It's a hybrid. Good year, yay! Bad year, no worse off than fully insured. There's a protective ceiling. What am I missing?
 
You pretty much got it. I've found level funded rates to be much better than fully insured plans, plus you get the claims data. The risk is, that protective ceiling goes away with some of the level funded carriers if the client drops the plan mid contract year. So that could be a huge problem if your client encounters financial difficulties and finds that they're having trouble maintaining their health plan which is more prone to happen with smaller employers than larger, more established ones. It also creates challenges if they ever want to change their open enrollment date.
 
I'm crushing the level funded in under 50. My avg saving vs ACA group is around 31%.
I've had a couple of cases where it's been 50%+ savings. Best cases are younger groups with about 20 EE with over $10K a month in premium but I've gone as low as 4 ee.
 
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