Meeting the Unique Needs of Each Client
We offer employer groups several funding options and work with decision makers to identify and choose one that best meets their priorities and needs.
Fully Insured (FI)
Fully-insured funding is the most straightforward and common funding arrangement. Employers pay premiums to Tufts Health Plan, and we pay providers for–and help manage–their employees’ care. Groups have the option to pay all or a percentage of your employees’ premium.
Fully-insured 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)
Self-insured funding arrangements are only available to large employer groups (51+ FTEs). With self-insurance, employer groups pay claims, hold the risk, and pay Tufts Health Plan administrative fees for managing the costs and care for your members. It’s common for employers to obtain reinsurance to cover high-cost claims.
Self-insurance can be a preferable option for companies that are comfortable taking on risk and those that have sufficient cash flow to manage varying monthly bills.
Our self funding arrangements are centered on:
- Efficient administration that reduces costs and helps your employees get the most out of their benefits
- Outstanding customer service from a local, non-profit health plan
- Dedicated account management with in-depth industry expertise
- Stop Loss policy embedded with our network rates to create savings premium, seamless servicing and improved reporting.
We deliver all this - and more - as one of the nation’s highest-rated plans for quality and service.
Self-insured groups are only subject to federal mandates, but many groups choose to cover state-mandated benefits as well. Contact your broker or a Tufts Health Plan representative if you’re interested in learning more.
Level Monthly Funding (LMF)
Level Monthly Funding (LMF) is designed to help large employer groups (51+ eligible employees/FTEs) that want the benefits of self-insured funding, but are wary of the risk, make the transition from fully insured to self-insurance.
Monthly claims can vary widely from month-to-month based on employee utilization, and that unpredictability can make a standard self-insurance arrangement unattractive for employers that may not have large, stable monthly cash flows. LMF provides employers with predictable monthly claims funding as a mechanism of easing into self-funding.
Contact your broker or sales executive to learn more more about LMF, how it works and whether it can help your company achieve its goals.
Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs)
Tufts Health Plan works third party administrators (TPAs) to provide integrated solutions for HSAs, HRAs, and FSAs. Each TPA provides excellent customer service and flexible options in order to meet companies’ needs.
The integration of claims and eligibility file feeds makes it easier for you to administer your HSAs, HRAs and FSAs.
Integration means a more seamless, hassle-free experience for employer groups. Tufts Health Plan can provide claims feeds directly to recommended TPAs, and can provide eligibility file feeds directly to a select group of them as well.
The integration of claims and eligibility file feeds makes it easier for employers to administer their HSAs, HRAs, and FSAs.