Shared/Partial Self-Funding

Shared/Partial Self-Funding:

  • High Deductibles and Out of Pocket Maximums are purchased (fully insured) from Wellmark. 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 employees. Wellmark sends a copy of the Explanation of Benefits directly to the T.P.A. (electronically) for reprocessing.
  • Typically, 509(A) requirements do not apply.