As the cost of healthcare continues to escalate, more and more brokers are looking for alternative solutions for their clients. HealthyAdvantage offers employers a powerful, practical alternative to fully insured plans. It allows your clients to directly fund their actual claim costs while limiting their risk with the purchase of stop-loss insurance.
With a 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 Third Party Administrators such as GBS to process, manage, pay the claims and provide member service 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 claim 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. GBS helps 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.