Discover the Benefits of Custom Health Plans
USA Benefits & Administrators helps employers take more control over their health plans. Our suite of products and services affords employers the flexibility to choose benefits that are meaningful to their employees while simultaneously reducing health care spend. This translates to greater participation and a healthier workforce.
Self funding is an alternative risk management strategy many employers use to provide health care benefits to their employees. Rather than paying monthly premiums to an insurance company, medical expenses are paid out of pocket as they are received.
At USA Benefits & Administrators, we work with our clients to design self-funding programs that meet their unique needs by considering options such as health, dental and vision benefits, short-term disability, prescription discounts and more.
Level funding is a hybrid between fully-insured plans and self-funded group programs which enables employers to budget for monthly expenses. Part of each monthly payment covers fixed costs (premium) and the remainder is used to pay expected claims. However, unlike fully-insured plans, a portion of any unspent claim funds are retained by the employer at the end of the program year.
Reference-Based Pricing (RBP)
Reference-based pricing is a system some employers use for cost containment purposes. With our help, employers negotiate with providers and set fixed limits on the amount their plan will pay for certain health care services. These limits are often based on a percentage or multiplier of what Medicare would pay the provider for the same services.
Minimal Essential Coverage (MEC)
Self- and level-funded Minimum Essential Coverage health care plan designs with USA Benefits & Administrators meet the requirements for Penalty A and improve participation rates among those employees who typically go without health insurance or rely on subsidies to purchase individual government plans. They are ideal for minimum wage, hourly or part-time employee groups and:
- Use a captive affiliate to facilitate cost effective risk ratio programs
- Promote stable monthly costs and potential for premium ROI year over year
- Meet the requirements for Penalty A as defined by the IRS and ERISA
- Help improve employee participation rates which can impact overall workforce health
Minimum Value Plan (MVP)
Self-funded and level-funded MVPs through USA Benefits & Administrators give employers a secure foundation for transitioning to a self-funding platform while offering employees the comprehensive coverage they expect at a considerably lower cost. Since these plans meet the requirements for both Penalty A and Penalty B, and they look and feel a lot like fully-insured health care programs, employee participation rates and overall workforce health tend to improve. This can lead to potential savings for the employer through reduced tax penalties and increased returns of unused premiums.