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Shared Funding / Partial Self - Funding
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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.
Iowa State 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 employee’s. Wellmark sends a copy of the Explanation of Benefits directly to the T.P.A. (electronically) for re – processing.
Typically, 509(A) requirements do not apply.
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