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The Best of Both Worlds: Self-Funding & Fully Insured Alternative & Partial Self-funding Helping Your Clients Find Self-Funded Alternatives To Insurance

The Best of Both Worlds: Self-Funding & Fully-Insured

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Are you and your clients frustrated with the rising costs of insurance premiums? Looking for a solution that provides them with additional flexibility and savings? Watch this free webinar!

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Page 1: The Best of Both Worlds: Self-Funding & Fully-Insured

The Best of Both Worlds:Self-Funding & Fully Insured

Alternative & Partial Self-funding Helping Your Clients Find Self-Funded Alternatives To Insurance

Page 2: The Best of Both Worlds: Self-Funding & Fully-Insured

The Best of Both Worlds:Self-Funding & Fully Insured

Alternative & Partial Self-funding Helping Your Clients Find Self-Funded Alternatives To Insurance

Page 3: The Best of Both Worlds: Self-Funding & Fully-Insured

What Is Alternative Funding?

Alternative Funding is J.P. Farley Corporation’s alternative to the limitations of fully insured products.

A new concept of plan design

taking the best attributes of Self Funding coverage as well as what works best by being fully insured.

Alternative Funding is also referred to as Partially Self-funding or SpagragetteTM.

Page 4: The Best of Both Worlds: Self-Funding & Fully-Insured

• Stability: Employer expenses remain steady every month.

• Control: Competitiveness to buyer moving from fully insured plan.

• Flexibility: ERISA plan Design. Avoid state mandates.

• Creativity: Underlying plan design.

of Alternative Funding or Partial Self-funding Coverage Advantages

Page 5: The Best of Both Worlds: Self-Funding & Fully-Insured

• Lower Maximum Cost – 3-9% less than Fully Insured

• No Underwriting required

• No Lasers (Even on renewal)

• Access to your claims information

• Potential for Reimbursement– Unlike fully insured products, should

the actual claims experience come in lower than expected at year end, reimbursement will occur. This is never an option with a fully insured product.

Financial Advantages

Page 6: The Best of Both Worlds: Self-Funding & Fully-Insured

• Transparent Pricing of Claims & Administration

– clearly auditable trail of every claim and administration dollar spent

– know exactly what you are paying for• Flexibility

– your plan designed your way

• Effective Plan Administration

– performance is better than large carriers

– improved service and lower costs

• Data & Information

– You can manage what you can measure!

Administration & Service Advantages

of Using A Third Party Administration

Page 7: The Best of Both Worlds: Self-Funding & Fully-Insured

Contract Terms

• Initial Policy Terms are 12/12.

• Policy Renews on a 24/12 basis.

• No requirement to go self funded or to renew the policy.

– J.P. Farley can provide the options.

• If client decides not to renew, terminal liability option (TLO) available.– Client pays 2 additional

months – For 6 months run out

coverage – Can be elected at the end of

the year

Page 8: The Best of Both Worlds: Self-Funding & Fully-Insured

• Available for plans with as few as 25 participants

• Ability to establish unit costs for single, 2-person and family coverage

• Stop loss protection

• Savings retained if claims lower than expected

Examine the Potential

Page 9: The Best of Both Worlds: Self-Funding & Fully-Insured

“Security and Stability”

• Alternative Funding options underwritten by top-rated carriers (Pan American & Gerber Life)

• No stop loss

• No cash calls

Security & Stability

Page 10: The Best of Both Worlds: Self-Funding & Fully-Insured

Comparing Products

Fully Insured

Alternative Funding

(Partial Self-funding)

Self-Funding

Specific deductible? No No Yes

TPA filing claims with carrier? No No Yes

Funding calls to employer? No No Yes

Laser ongoing claimants? No No Yes

Fully funded Yes Yes No

Monthly budget? Yes Yes No

Is it for a max cost buyer? Yes Yes No

Federally regulated ERISA platform No Yes Yes

Flexible plan design No Yes Yes

Upside potential if group run well? No Yes Yes

Various contract types? No Yes Yes

Lots of similar product competitors? Yes No Yes

Guaranteed issued? Yes No No

Page 11: The Best of Both Worlds: Self-Funding & Fully-Insured

Comparing Administrators

What All of Us Say They Do…• Low Cost• Results Oriented• Strategic Thinking• Comprehensive Data Analysis &

Reporting• Plan Design Flexibility• State of the Art, Fully Integrated

Systems• Subrogation & Recovery Process• Wellness & Prevention• Great Service• Personal Attention• Dedicated Staff

Page 12: The Best of Both Worlds: Self-Funding & Fully-Insured

Comparing Administrators

• Fully integrated URAC accredited Utilization Management • Service & Accuracy Measurements and Guarantees• Billing Advocacy and Collections Assistance Program• Maximum Carve Out Utilization

– Carve Out Specialty Pharmacy– Carve Out Oncology Management Program– Carve Out Out-of-Network Claims Using Medicare Fee

Schedule • Effective Plan Design & Plan Language to Maximize Carve

Out Programs– Avoid Over-reliance on Network & Discounts to Manage the

Plan• Claims Edit System utilizing all available edits for

maximum cost effectiveness• On going eligibility audit program• Respect of Plan’s finances

Those Who Go Beyond…

Page 13: The Best of Both Worlds: Self-Funding & Fully-Insured

Comparing Administrators

• J.P. Farley protect companies from a health - and financial – perspective since 1979.

• In-house – Fully integrated URAC Accredited Utilization Management

• Service & Accuracy Measurements and Guarantees

• Patient Billing Advocacy and Collections Assistance Program

J.P. Farley Has A Better Plan…

Page 14: The Best of Both Worlds: Self-Funding & Fully-Insured

We Have A Better Plan

• Maximum Carve Out Utilization– Carve Out Specialty Pharmacy

– Carve Out Oncology Management Program

– Carve Out Out-of-Network Claims Using Medicare Fee Schedule

• Effective Plan Design & Plan Language to Maximize Carve Out Programs

– Avoid Over-reliance on Network & Discounts to Manage the Plan

• Specialized Services Approach

Page 15: The Best of Both Worlds: Self-Funding & Fully-Insured

We Have A Better Plan

• Claims edit system utilizing all available edits for maximum cost effectiveness

• On going eligibility audit program

• We treat your expenditures like they are our expenditures.

• Demonstration of our commitment to high-quality process, procedures, staff and service– ISO 9001-2008 Certified– URAC Accreditation– NorthCoast 99 Best Place to Work Award Repeat

Winner

• Our self-funded solutions and strategic thinking delivers measurable value. We will prove that to you.

Page 16: The Best of Both Worlds: Self-Funding & Fully-Insured

We Have A Better Plan

Page 17: The Best of Both Worlds: Self-Funding & Fully-Insured

What Info Is Needed?

To quote all that is needed is:• Current Census• Summary of Benefits• Current Fully Insured Rates• Renewal Fully Insured Rates

Obtaining a Quote for Partially Self-funded is Easy.

Page 18: The Best of Both Worlds: Self-Funding & Fully-Insured

Alternative Funding Solutions

Call J.P. Farley for more details at 800.634.0173 and implement a better plan.

Robert Bernath [email protected]

Jason Smith [email protected]

or visit our website at jpfarley.com