Shared Funding / Partial Self-Funding

• High deductibles and out-of-pocket maximums are purchased (fully insured) from Wellmark Blue Cross/Blue Shield. Those fully insured benefits are brought down to desired levels. The difference between the fully insured out-of-pocket and the desired out-of-pocket is self-funded.
• Claims are paid as incurred
• Rates are guaranteed for 12 months
• Coverage is guaranteed to all entrants - no lasers
• State of Iowa mandates apply to the covered features
• HIPAA requires an administrator to provide partial self-fund claims processing
• Risk is diminished compared to a self-funded plan
• 3 - 5% savings compared to a comparable fully insured plan
• Partial self-funded claims are paid directly to the provider
• No additional work for employees. Wellmark sends a copy of the Explanation of Benefits directly to the third party administrator (electronically) for re-processing.
• Typically, 509(A) requirements do not apply