United Healthcare Level Funded Program
Level Funded is a unique policy that is worth showing all of your groups to see if they qualify. There are some benefits you may not be aware of. Below are 10 frequently asked questions on the subject!
What is Level Funded?
Level Funded is an insurance policy, written outside the ACA, reserved only for good risk. It is a Preferred Risk product.
What’s the benefit of Level Funded?
Employers who qualify, typically see 10-30% lower monthly rates compared to a stock ACA plan (best bang for buck). And as an extra benefit, if a group has lower claims than expected throughout the year, a renewing employer may receive a surplus on part of their premiums.
This sounds too good to be true, what’s the catch?
There is no catch. Your group needs to qualify to see if they are eligible.
How do I know if a group is healthy?
Contact your Broker Service Specialist here at Midwest. We will look over the data and work with UHC to get you the best rates.
I’ve never heard of this, how long has Level funded been around?
UHC’s Level Funded program has been around since 2014, and has maintained a persistency rate of about 88% locally and nationally.
In addition to renewing a very high percent of groups, 43.5% of groups are getting a surplus of premium returned to them for renewing.
The average surplus refund is $9863.
What types of plans and networks are available?
You will have access to traditional PPO’s, HMO’s, as well as in-network only plans. Networks include national and local networks. Our team at Midwest will make it easy to find the right network and plan at the right price.
If a group has higher than expected claims, how much extra will they have to pay?
Nothing! ALL insurance costs are built into the premium through the contract. Worst case scenario: you leave and go back to an ACA plan without owing ANY money to UHC.
Does the employer have any financial liability if they leave UHC for another carrier after renewal?
Claims for covered services while insured are covered for 60 months after a plan terminates. There is NO additional financial exposure or money due UHC.
How do I know what doctors and hospitals I have access to?
Several Networks, both locally and nationally. UHC has an easy to use provider finder tool. If you have any questions, contact your BSS and we will help analyze what your groups qualify for and have access to.
What are the participation guidelines?
The Level Funded program typically targets groups 10+ and requires a 50% participation rate, regardless of waivers. Certain smaller groups may also be eligible, but may require a higher percentage of participation.
Owner only groups and husband/wife groups are NOT eligible.
Please contact your BSS for any clarifications.