Flagship Planning Solutions

Besides traditional fully-insured group plans through several carriers, we offer Partial Self-Funding Plans through several fine Administrators and Stop-Loss Carriers.

HRA (Health Reimbursement plans),
Flex-Spending Plans,
Health Savings Accounts (HSAs)

We are well known for developing group solutions that work for employers looking beyond 'cookie-cutter' benefit plans.

Other Group Benefits:

Employee & Dependent Life Insurance --
Short & Long-Term Disability

Dental & Vision Insurance

Accidental Death & Travel Accident

Critical Illness --
Limited Benefit Plans
Group & Voluntary Long-Term Care

Also Truckers Occupational Coverage &

Plans for Self-Employed Individuals

We can incorporate Wellness Programs and Employee Assistance Programs into our benefit plans. These can be offered at very little additional employer cost.

Flagship Planning has a variety of Voluntary Benefit products to enhance a program.

HSA INFORMATION
HRA INFORMATION
Section 125 / FlexPlan Information
Section 105 Information

Partially Self-Funded Plans: Employers with over 100 participants are more likely to consider a partially self-funded plan. Why?

Insurance carriers price group insurance for the ‘worst case’ risk possibility because they have to set aside ‘reserves’ to pay claims, even after the plan year ends. If an employer is willing to assume part of the risk for claims under a certain amount, usually $25,000 or more, the insurance company will substantially reduce the insurance premium. The employer contracts with an administrator instead of an insurance to manage the plan on the employer’s behalf. This allows the employer to change insurance companies without having to switch plans or do new enrollments.

Employers can custom-design the plan’s benefits and modify some plan provisions. Unlike small group plans and fully insured plans, a self-funded plan is not subject to all of the state group insurance regulations and mandated coverages. Instead these plans are governed by Federal rules under ERISA.

These cases are usually underwritten based on past claims experience and employer disclosures of known health conditions.

Can smaller employer buy self-funded plans? Yes, but few stop-loss carriers are willing to take these cases and those who do underwrite more like a fully insured plan, requiring short-form individual health questionnaires. Companies can also require an employer to ‘self-insure’ a higher deductible, called a laser, for some known or on-going health conditions.

We represent two plans that specifically work with groups 25 or more participants.

This is a good way for an employer to avoid paying max rated fully insured premiums by assuming the costs only if medical claims costs are actually incurred.

Self-Funded Plans have their own language. –

Specific - The employer’s deductible amount per claim

Specific Premium – Actual insurance premium to cover claims that exceed the employer’s liability per claim

TPA- Third Party Administrator - A firm that administers the plan, acting like an insurance company. They handle billings, claims administration, census changes and more.

Stop-loss – Refers to the type of insurance coverage, meaning ‘stop employer loss’. Also known as ‘reinsurance’.

Aggregate Premium – An additional premium to cap the employer's overall claims liability each year.

Aggregate Factor – The maximum required funding to cover the maximum employer claims liable per employee and employee with dependents.

Aggregate Liability—The overall maximum employer claims liability for each plan year.

Expected Cost – This is the amount of claims the insurance carrier expects the employer to actually pay.

Claims account – A self-funded plan has three premium parts, Administration Costs, Premiums, and

Aggregate Factors. The Aggregate Factor payments go into an escrow account to pay the employer’s share of the claims.

12/12; 12/15; 18/12 – Basic Plan Year Designs. Claims incurred during the plan year and submitted are covered under a 12/12 plan but claims incurred but not submitted until after the plan year ends are not covered under the plan.

12/15; 12/18 -- extends the claims payment period for three or six months after the end of the plan year

15/12; 18/12; 24/12-- covers claims that were incurred in a prior plan year in the current plan year. Usual plan design after the 1st year under a 12/12 plan design.

Terminal Liability – If the employer terminates the group plan, there is still liability for claims that were incurred but not yet paid. The employer can buy short-term stop-loss coverage and administration services to handle those unknown ‘run-out’ claims.

Individual Health Insurance Products in Employer-Sponsored Plans.

Individual Major Medical, Short-Term, and Limited Benefit Plans.

Employers can offer individual health plans instead of group insurance. This is especially popular for smaller groups. The employer has to be careful when offering this option to avoid it being considered ‘group insurance’.If you have an employer who wants to offer individual health plans or Limited Benefit Plans, contact us before proceeding. Following a couple simple rules can avoid employee terminations, tax penalties or employee lawsuits.

CRITICAL ILLNESS - The new form of insurance protection for a new age. Medical Science allows us to survive illnesses that were fatal even 5 years ago, but at what cost? 50% of the costs for many Major Illnesses are not covered by traditional insurance products. This is a simple plan to add to the group insurance program, especially high deductible plans and self-funded plans.

Group Medicare Supplement Plans are also available for employers with more than 10 employees eligible for Medicare. The employer can also offer a wide choice of prescription drug plans.