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Employer pays set amount monthly to plan
Insurance Co. assumes financial risk
Employer assumes financial risk
Network Re-pricing of Claims (cost savings tool)
Large Case Management (cost savings tool)
Utilization Management (cost savings tool)
Reinsurance (pooling point) or Stop Loss
Excess profit retained by employer
Excess profit retained by insurer
Healthcare Premiums are on the rise. Traditional Healthcare is starting to be replaced by self-funded healthcare to save thousands in premiums. While the benefits that are self-funded are extremely attractive, most employers don’t want to perform the task of administering the plan which includes processing and paying claims, as well as other functions. Some employers will contact a Third Party Administrator to handle this responsibility for them.
Self-Funded Health Plans
A fully insured health plan can cut the premium price by half for an employer without sacrificing benefits when the employer elects to self- fund the employee’s deductible. When an employer uses a Third Party Administrator, the self- funded portion is handled by the TPA for the employer, in addition to paying claims only when services occur.
Fully Insured Health Plan
This trust fund plan includes Medical, Dental, Vision, Life and Pension access. This plan usually covers employees and their dependents in a specific industry. It is managed by a joint board of union and employer trustees that work together to benefit both the employee and union members. This type of plan has complex eligibility rules, such as Skip-Month Eligibility. The employer transmits hours worked for current month to ensure coverage for the following month. In addition, this plan can provide multiple plan designs, as well as a defined contribution or benefit plan for retirees.
Taft-Hartley Welfare Health Plan
We use DentAssure to fully insure members via Indemnity or PPO plans offering coverage through Dental Health Alliance and EyeMed carriers across the nation.
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. We use our cost-effective approaches to minimize cost and manage complex compliance issues.
This benefit coverage can be used for Individual Specific Coverage or Aggregate Group Coverage. This coverage is designed to minimize the risk of medical claims an employee or group of employees incur.
Stop Loss Plans
These plans let you set aside a predetermined amount from your paycheck before taxes are calculated, which you have access to throughout the year. There are several Flexible Spending Account Plans we offer. They are:
Flexible Spending Account Plans
When your employer provides you with health benefits, you are able to set aside money to use in this pre-tax account to pay for your portion of your monthly premiums, instead of it coming out of your paycheck.
When you have to pay for your co-pay or deductible for a qualified health service, you can seek reimbursement for these services through your pre-tax account, that you have set aside money that can be used for these expenses.
When you have dependent care expenses for eligible children residing with you, through payroll deductions, you can set aside pre-tax money to cover your daycare expenses. Eligibility requirements are
There are additional benefits available such as accident insurance, cancer insurance, critical illness insurance, heart/stroke insurance that you may be eligible for coverage.
-be a child under the age of 13
-be a child, spouse or other dependent who is physically or mentally incapable of self-care
-all dependents must spend at least 8 hours a day in your household.
Premium Savings Account
Healthcare Reimbursement Account
Dependent Daycare Reimbursement Account
Phone 800.562.9383 Fax 916.921.3383
Integrity Administrators, Inc.
EXCELLENCE IN THIRD PARTY ADMINISTRATION
Contact Integrity Administrators, Inc. to find out more information at 1.800.562.9383 or use the Contact Us tab.
Fully Insured vs Self-Funded Plans