Plan Architecture & Funding Strategy

On a fully insured plan you buy claims, administration, and a margin the carrier keeps whether or not your people got sick. You never see the split, and you never get the claims file, so every renewal is a number you are asked to accept without the evidence behind it. How a plan is funded decides more than any program sitting on top of it, and almost nobody opens it.

Tests the plan's funding and design against the full range of alternatives · level-funded, captive, and self-funded structures with a stop-loss layer · defined-contribution and individual-coverage arrangements where they fit · transparent pass-through pharmacy contracts · dependent eligibility and payment-integrity audits · models the options against your census and claims history, then implements the one that fits the group.

Employers of any size still on a fully insured plan, or on a funding structure they inherited rather than chose. Health systems and multi-site employers with enough census to carry their own risk.

Opens the layer beneath every other cost lever · Returns the claims data the diagnostic measures against · Keeps the existing broker, doctors and cards in place