Tri-Level Limited-Day Health Plans for Employers

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Level-funded copay plans with NO DEDUCTIBLE - Benefits pay on an Expense-Incurred basis

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Webinars are on Wednesdays, webinar 1 in the morning and webinar 2 in the afternoon.

Professional Woman

FOR THE EMPLOYER

  • Requires 50% employer contribution

  • Level funded with stop-loss insurance for excess claim risk protection and refund potential based on utilization

  • Minimum of 10 enrolled lives or 30% of eligible employees

  • Affordable core plan options for both small and large employers alike

  • Meets ACA “Minimum Essential Coverage” AND "Minimum Value" definitions

Employee

FOR THE EMPLOYEE

  • Preventative Services covered 100%

  • 60-70% of the cost of HDHPs

  • NO deductible

  • Low copays

  • No health questions

  • Telemedicine with NO copay

  • EAP with 5 face to face counselor visits covered

  • LabCard - Free diagnostic testing at Quest Diagnostics

WHAT IS LEVEL FUNDING?

Level funding allows small employers to manage¹ the risk for large claims, while enjoying the cost savings and refund² potential of self-funding a health plan.

Twelve level monthly payments each year covers¹ the costs for your plan, with the potential for earning a refund² at the end of the year.

¹Large claim risk managed by stop-loss insurance with run-out coverage, subject to policy exclusions, solvency of insurance carrier, policy effective dates, mid-year Plan termination, and other policy terms and conditions.
²Refund subject to claims experience, run-out claims, mid-year Plan termination, and the terms and conditions of the administrative agreement.

Manager at Construction Site

THE AFFORDABILITY CRISIS​

Millions of employees can’t afford the employee contribution on their employer-sponsored medical plan.

Many employees who can, realize that they could never come up with the $2,000 to $6,000 necessary to meet their deductible.

THE SOLUTION

Our expense-incurred plans make it easier for employees to budget for their healthcare expenses. Since there is no deductible, they simply pay a copay for covered services. Our plans take care of the rest. For employers, These plans provide protection from both the "A" and "B" penalties, and the built-in level-funding also means predictable costs. As a result, these plans are unlike any other health plans in the market today

LEVEL-FUNDED LIMITED-DAY PLANS INCLUDE:

  • Preventative Services covered with no copay

  • Outpatient care

  • Inpatient Hospitalization (5 Days)

  • Surgeries

  • Generic Rx
     

EXPENSES COVERED AT 100% AFTER COPAY

Facilities-Based Approach
Reference Based Pricing (RBP) is the future of healthcare.  Fundamental Care utilizes a national network for outpatient, everyday expenses, and RBP for physicians and inpatient care.  It gives members the best of both worlds with the most innovative plan design the industry has seen yet.

Patient Advocacy 
We ensure members get all the support they need.  Whether it's before a procedure or after, our patient advocacy partners help with things like pre-certification and billing disputes.  Health insurance can be confusing and intimidating to many.  Our valued members do not have to go through this alone.

Colleagues

The Fundamental Care Limited-Day Plans are ideal for groups of all sizes who can’t afford major medical coverage for employees.

 

These plans include more comprehensive benefits than indemnity-based limited-benefit plans. As a result, employers that cannot offer Major Medical to their entire employee population will still have a valuable tool to recruit and retain high-quality employees.
 

WHAT ARE THESE PLANS DESIGNED TO ACCOMPLISH?
  • Give large employers protection from BOTH ACA penalties
     

  • Create a solution for smaller employers as a core plan when they cannot afford to offer their employees an ACA-compliant MVP.

  • Outpatient & Inpatient coverage can be offered without the MVP.

  • Outpatient can be offered as a stand-alone to really keep costs down.
     

  • Give employees the freedom to choose the types of benefits that meet their needs and budget.
     

  • Provide an affordable, group health insurance solution that is ideal for industries like restaurants, retailers, staffing firms, construction companies, and security guard firms.

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