Q: Because this program is technically a ‘Self Funded’ Program, does that mean our group has to have reserves set aside to cover the claims in case of a bad month (or year)?
A: NO. Because of the insurance components of the program, we have taken the best aspects of a selffunded program and the best aspects of a fully-insured program and blended them together. This is a fixed-cost, level-funded program. Your rates are your rates, period.
Q: What does Level Funded mean?
A: The Lifestyle Health Program is ‘level funded’ meaning that by design, any risk to the sponsoring employer has been removed beyond the 12 months of premium paid. Based on employer size, we can offer a unique, self-funded health benefit program that maximizes the benefits to employees, while implementing cost-saving opportunities for employers to stabilize benefit costs without reducing benefits.
Q: If our claims exceed the allotted amount, what happens? Do we have to come up with the difference at the end of the year?
A: NO. The Lifestyle Health Program is level funded by your monthly premiums. Regardless of what your claims experience is in any given plan year, you will never pay more than the monthly cost quoted to you
Q: If we choose to leave the program at the end of the plan year, is there a termination cost associated with the plan?
A: NO. All run out costs are accounted for within the monthly premiums.
Q: During our plan year, what if our claims run better than expected?
A: Once all claims have been paid for the plan year, any unused dollars in the claims fund will be used to reduce future premium rate increases. In the event of a plan termination, each employer is eligible to receive back any unused dollars in the claims fund after the run out period.
Q: Will our employees and administrators have to do more work on this type of program?
A: NO. By partnering with Medova Healthcare, the program’s Third-Party Administrator (TPA), administrative burdens are removed from both the employee and the employer. Employees play their usual role including seeing providers within their PPO Network, using their ID card at the provider’s office, paying a copay and then paying their shared responsibility. The employer simply pays their monthly premiums. Medova then handles the rest! No claims filing, no separate accounting, no extra work!
Q: Are there any startup costs to our Lifestyle Health Plan?
A: The only start-up cost is your first monthly premium payment.