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Level-Funded Plans

What do Level-Funded Plans Offer?

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A level-funded major medical plan is a type of self-insured health plan where an employer pays a fixed monthly fee to cover the costs of claims, administration, and stop-loss insurance.

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Employers with a level-funded plan are insured against higher-than-expected claims and may get a surplus refund in the end, if annual medical claims are lower than expected

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Employers with level-funded plans pay a fixed monthly rate that covers both stop-loss insurance costs and potential medical claims.

What does the Process Timeline look like?

90 Days Prior to Effective Date:
;
Quoting can begin.
60 Days Prior to Effective Date:
;
• Quotes need to be rerun.
• HealthApps must be completed.
• Retroactive adjustments are limited to 60 days and cannot cross plan years.
15 Days Prior to Effective Date:
;
• The quote must be moved to implementation status in eDIYBS.
• Monthly bills and paperwork are generated.
• Deadline for voluntary benefit enrollment for this month’s effective date.
During Open Enrollment:
;
• Any additions or deletions during this period will require the proposal to be rerun. Rates will not be held.
By the Effective Date:
• ID cards will be available if the group is implemented with the TPA two weeks prior to the effective date. Otherwise, temporary ID cards will be available
within 48 hours of implementation with the TPA.
• The first month’s premium will be pulled.
Cancellation Policy:
;
• If any enrollment changes are made after the group is moved to implementation, the effective date must be moved to the following month.
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Quote Example for a Level-Funded Plan

This is an example for a company with a census for over 100 employees. Prices in this table may vary. Contact us if you wish to get an accurate quote that reflects your needs.

Contract Terms:

Carrier
Network
Agg Basis
Agg Max
Agg Advance
Spec Deductible
Spec Max
Cigna
Cigna
12/18
$1,000,000
Yes
$20,000
Unlimited

Spec Deductible 20,000

eDIYBS Platinum E100
eDIYBS Platinum E101
eDIYBS Platinum E102
eDIYBS Gold E200
eDIYBS Gold E201
eDIYBS Gold E202
eDIYBS Gold E203
eDIYBS Silver E302
eDIYBS Silver E303
eDIYBS Bronze E403
eDIYBS Bronze E404
eDIYBS Bronze E405
EEs (88)
$666.22
$631.66
$642.62
$613.17
$590.91
$591.95
$615.57
$557.02
$558.04
$505.66
$476.23
$491.29
ESs (0)
$1,348.45
$1,250.06
$1,281.23
$1,197.47
$1,134.15
$1,137.08
$1,204.29
$1,037.72
$1,040.64
$891.63
$807.86
$850.71
ECs (1)
$1,485.63
$1,374.42
$1,409.65
$1,314.96
$1,243.40
$1,246.69
$1,322.68
$1,134.38
$1,137.68
$969.23
$874.54
$922.98
EFs (5)
$2,059.52
$1,894.63
$1,946.87
$1,806.50
$1,700.37
$1,705.28
$1,817.90
$1,538.77
$1,543.66
$1,293.90
$1,153.50
$1,225.33
Annual Fixed
$583,353.36
$560,087.16
$567,463.56
$547,638.24
$532,650.84
$533,351.88
$549,250.56
$509,831.88
$510,521.28
$475,252.44
$455,446.44
$465,582.48
Annual Funding
$261,573.72
$237,116.64
$244,871.16
$224,038.80
$208,293.12
$209,024.40
$225,737.52
$184,320.00
$185,040.72
$147,989.28
$127,156.92
$137,815.32
Annual Max
$844,927.08
$797,203.80
$812,334.72
$771,677.04
$740,943.96
$742,376.28
$774,988.08
$694,151.88
$695,562.00
$623,241.72
$582,603.36
$603,397.80

Summary of Benefits

Deductible (Indv - Family)1
Deductible Type
Plan Type
Primary/Specialist/
Urgent Care
Wellness/Preventative
X-Ray/Lab
Emergency Room2
OOP Max (Indiv - Family)
In-Patient Hospitalization
Out-Patient Surgery
Prescription Drugs (Tier 1)
Prescription Drugs (Tier 2)
Prescription Drugs (Tier 3)
Prescription Drugs (Specialty)
eDIYBS Platinum E100
$250/$500
Embedded
Co-pay
$25/$45/$45
100% Covered
20% After Deductible
20% After Deductible
$1,250/
$2,500
20% After Deductible
20% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Platinum E101
$1,250/
$2,500
Embedded
Co-pay
$25/$45/$45
100% Covered
0% After Deductible
$300.00
$1,250/
$2,500
0% After Deductible
0% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Platinum E102
$0/$0
Embedded
Co-pay
$25/$45/$45
100% Covered
50% After Deductible
$300.00
$1,250/
$2,500
50% After Deductible
50% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Gold E200
$1,000/
$2,000
Embedded
Co-pay
$15/$40/$40
100% Covered
20% After Deductible
$300.00
$3,500/
$7,000
20% After Deductible
20% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Gold E201
$3,300/
$6,600
Embedded
HSA
0% After Deductible/0% After Deductible/0% After Deductible
100% Covered
0% After Deductible
0% After Deductible
$3,300/
$6,600
0% After Deductible
0% After Deductible
0% After Deductible
0% After Deductible
0% After Deductible
Contact PBM
eDIYBS Gold E202
$3,250/
$6,500
Embedded
Co-pay
$30/$50/$50
100% Covered
0% After Deductible
$400.00
$3,250/
$6,500
0% After Deductible
0% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Gold E203
$1,500/
$3,000
Embedded
Co-pay
$35/$55/$55
100% Covered
20% After Deductible
$500.00
$3,000/
$6,000
20% After Deductible
20% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Silver E302
$3,000/
$6,000
Embedded
Co-pay
$35/$55/$55
100% Covered
20% After Deductible
$500.00
$6,000/
$12,000
20% After Deductible
20% After Deductible
$0.00
$35.00
$75.00
Contact PBM
eDIYBS Silver E303
$3,300/
$6,600
Embedded
HSA
20% After Deductible/20% After Deductible/20% After Deductible
100% Covered
20% After Deductible
20% After Deductible
$6,600/
$13,200
20% After Deductible
20% After Deductible
0% After Deductible
25% after Ded.
45% after Ded.
Contact PBM
eDIYBS Bronze E403
$5,000/
$10,000
Embedded
Co-pay
$40/$80/$60
100% Covered
30% After Deductible
30% After Deductible
$8,700/
$17,400
30% After Deductible
30% After Deductible
$0.00
$35.00
$75.00
Contact PBM

Lets Discover what your options are for a Level-Funded Plan Today!

Contact Gesla Insurance Agency now to speak with our expert advisors and find the perfect coverage for your needs.

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