The Best of Both Worlds: Self-Funding & Fully Insured Alternative & Partial Self-funding Helping Your Clients Find Self-Funded Alternatives To Insurance
May 24, 2015
The Best of Both Worlds:Self-Funding & Fully Insured
Alternative & Partial Self-funding Helping Your Clients Find Self-Funded Alternatives To Insurance
The Best of Both Worlds:Self-Funding & Fully Insured
Alternative & Partial Self-funding Helping Your Clients Find Self-Funded Alternatives To Insurance
What Is Alternative Funding?
Alternative Funding is J.P. Farley Corporation’s alternative to the limitations of fully insured products.
A new concept of plan design
taking the best attributes of Self Funding coverage as well as what works best by being fully insured.
Alternative Funding is also referred to as Partially Self-funding or SpagragetteTM.
• Stability: Employer expenses remain steady every month.
• Control: Competitiveness to buyer moving from fully insured plan.
• Flexibility: ERISA plan Design. Avoid state mandates.
• Creativity: Underlying plan design.
of Alternative Funding or Partial Self-funding Coverage Advantages
• Lower Maximum Cost – 3-9% less than Fully Insured
• No Underwriting required
• No Lasers (Even on renewal)
• Access to your claims information
• Potential for Reimbursement– Unlike fully insured products, should
the actual claims experience come in lower than expected at year end, reimbursement will occur. This is never an option with a fully insured product.
Financial Advantages
• Transparent Pricing of Claims & Administration
– clearly auditable trail of every claim and administration dollar spent
– know exactly what you are paying for• Flexibility
– your plan designed your way
• Effective Plan Administration
– performance is better than large carriers
– improved service and lower costs
• Data & Information
– You can manage what you can measure!
Administration & Service Advantages
of Using A Third Party Administration
Contract Terms
• Initial Policy Terms are 12/12.
• Policy Renews on a 24/12 basis.
• No requirement to go self funded or to renew the policy.
– J.P. Farley can provide the options.
• If client decides not to renew, terminal liability option (TLO) available.– Client pays 2 additional
months – For 6 months run out
coverage – Can be elected at the end of
the year
• Available for plans with as few as 25 participants
• Ability to establish unit costs for single, 2-person and family coverage
• Stop loss protection
• Savings retained if claims lower than expected
Examine the Potential
“Security and Stability”
• Alternative Funding options underwritten by top-rated carriers (Pan American & Gerber Life)
• No stop loss
• No cash calls
Security & Stability
Comparing Products
Fully Insured
Alternative Funding
(Partial Self-funding)
Self-Funding
Specific deductible? No No Yes
TPA filing claims with carrier? No No Yes
Funding calls to employer? No No Yes
Laser ongoing claimants? No No Yes
Fully funded Yes Yes No
Monthly budget? Yes Yes No
Is it for a max cost buyer? Yes Yes No
Federally regulated ERISA platform No Yes Yes
Flexible plan design No Yes Yes
Upside potential if group run well? No Yes Yes
Various contract types? No Yes Yes
Lots of similar product competitors? Yes No Yes
Guaranteed issued? Yes No No
Comparing Administrators
What All of Us Say They Do…• Low Cost• Results Oriented• Strategic Thinking• Comprehensive Data Analysis &
Reporting• Plan Design Flexibility• State of the Art, Fully Integrated
Systems• Subrogation & Recovery Process• Wellness & Prevention• Great Service• Personal Attention• Dedicated Staff
Comparing Administrators
• Fully integrated URAC accredited Utilization Management • Service & Accuracy Measurements and Guarantees• Billing Advocacy and Collections Assistance Program• Maximum Carve Out Utilization
– Carve Out Specialty Pharmacy– Carve Out Oncology Management Program– Carve Out Out-of-Network Claims Using Medicare Fee
Schedule • Effective Plan Design & Plan Language to Maximize Carve
Out Programs– Avoid Over-reliance on Network & Discounts to Manage the
Plan• Claims Edit System utilizing all available edits for
maximum cost effectiveness• On going eligibility audit program• Respect of Plan’s finances
Those Who Go Beyond…
Comparing Administrators
• J.P. Farley protect companies from a health - and financial – perspective since 1979.
• In-house – Fully integrated URAC Accredited Utilization Management
• Service & Accuracy Measurements and Guarantees
• Patient Billing Advocacy and Collections Assistance Program
J.P. Farley Has A Better Plan…
We Have A Better Plan
• Maximum Carve Out Utilization– Carve Out Specialty Pharmacy
– Carve Out Oncology Management Program
– Carve Out Out-of-Network Claims Using Medicare Fee Schedule
• Effective Plan Design & Plan Language to Maximize Carve Out Programs
– Avoid Over-reliance on Network & Discounts to Manage the Plan
• Specialized Services Approach
We Have A Better Plan
• Claims edit system utilizing all available edits for maximum cost effectiveness
• On going eligibility audit program
• We treat your expenditures like they are our expenditures.
• Demonstration of our commitment to high-quality process, procedures, staff and service– ISO 9001-2008 Certified– URAC Accreditation– NorthCoast 99 Best Place to Work Award Repeat
Winner
• Our self-funded solutions and strategic thinking delivers measurable value. We will prove that to you.
We Have A Better Plan
What Info Is Needed?
To quote all that is needed is:• Current Census• Summary of Benefits• Current Fully Insured Rates• Renewal Fully Insured Rates
Obtaining a Quote for Partially Self-funded is Easy.
Alternative Funding Solutions
Call J.P. Farley for more details at 800.634.0173 and implement a better plan.
Robert Bernath [email protected]
Jason Smith [email protected]
or visit our website at jpfarley.com