Different clients have different needs when it comes to funding their plan.
We offer the following solutions so you can help your clients choose the one that fits best.
Fully Insured (FI)
The employer pays the premiums and we pay the providers. Premiums are based on the group’s community-rated risk or claims history. The employer pays all or a percentage of their employees’ premium. We pay for and help manage their care. FI funding is available to large and small groups. Plan design is subject to all state and federal mandates.
Self-Funded (SI)/Administrative Services Only (ASO)
We manage the costs and the care; the employer pays the providers. This option is for your clients who are comfortable with taking on risk and have the cash flow to manage varying monthly bills. We work with the employer to make sure they are getting what they need and pay for.
With self-funding, the group pays for claims, holds the risk, and pays Tufts Health Plan ASO fees. In many cases, the group will obtain reinsurance through another carrier to cover high-cost claims.
Self-funding is only available for large groups. Plan design is only subject to federal mandates, but many groups choose to cover state-mandated benefits as well.
Level Monthly Funding (LMF)
Our Level Monthly Funding option is designed for employer groups with a minimum of 51 enrolled employees, who are currently fully insured and want to make the switch to self insured funding. Level Monthly Funding allows the smaller employer group to ease into the concept of self-funding, with predictable monthly claims funding.
Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs)
We work with a select group of third party administrators (TPAs) to provide integrated solutions for HSAs, HRAs and FSAs. Each of the TPAs provides excellent customer service and flexible options to meet your clients’ needs.
Integration means a more seamless, hassle-free experience for the employer. We are able to provide claims feeds directly to all our recommended TPAs. In addition, we offer an enhanced capability with some of the TPAs in which we’re able to provide eligibility file feeds directly to them. The integration of claims and eligibility file feeds makes it easier for employers to administer their HSAs, HRAs and FSAs.