One mission: you

BalancedFundingfor groups with

51-250 employees

Form No. 3-1205 (02-17)

Looking for a new funding option for your group health plan?Blue Cross of Idaho’s Balanced Funding1 program is a self-funded health plan with the predictability of a stable monthly payment and protection against losses.

Balanced Funding

How it WorksBalanced Funding is available to groups with 51 to 250 enrolled employees.

Step 1.

Step 2.

Step 3.

Blue Cross projects your expected claims and bundles it with specific and aggregate stop-loss insurance2 to create a level monthly payment.

Your monthly payment covers administrative costs and stop-loss insurance, along with claims funding and claims run-out liability, based on enrollment.

If your actual claims experience is lower than expected, and there is a surplus after fixed costs are paid, you could receive a surplus credit after the run-out period.

2 Integrated stop-loss starting at $25,000 for specific claims and 110% for aggregate claims funding.

Fully Insured

Tax SavingsPotential for Surplus CreditPlan Cost Transparency

Fixed Monthly PaymentsCap on Financial ResponsibilityProtection Against Losses

Balanced Funding

Save MoneyPredictable Monthly PaymentPotential for a Surplus CreditProtection Against Losses

Conventional Self-funded

TYPES OF FUNDINGADVANTAGES:

1 Balanced Funding is a type of self-funding with level payments. As a self-funded group plan, additional actions and responsibilities will apply. Please work with your legal counsel to ensure compliance with ERISA, HIPAA and any other applicable Federal or State requirements.

Plan BenefitsPlan administration includes a monthly accounting report to shed light on your actual claims experience. You may also be exempt from some taxes and fees.

BLUE CROSS OF IDAHO INSURANCE PLANS / BALANCED FUNDING

Network options – broad and managed care networks support Balanced Funding with comprehensive medical and embedded pharmacy benefits.

Ancillary services – utilization management, case management and disease management programs, along with our wellness portal, are included.

Buy-up products – option to add dental, vision and EAP products or services like Nurse Advice Line, Ways to Save, advanced wellness programs, identity theft protection.

Embedded Pharmacy The Balanced Funding program includes CVS/Caremark pharmacy benefits management:

• 6-tier formulary with preferred and non-preferred drugs

• Generic, brand, specialty drugs with copay and some deductibles

• Preventive and maintenance drugs have minimal OOP costs

Please contact your insurance agent, sales representative or account manager for details on this new Balanced Funding program, including a pharmacy rebate.

Note: Contract termination charges will apply. Early termination (before renewal) may not generate any surplus after these fees are deducted.

Strike the Right Balance – Flexible plans, Predictable costs

Remember, with Blue Cross of Idaho’s Balanced Funding program, if your claims are lower than anticipated,

you may receive a credit back after fixed costs are paid. If claims run higher than expected, don’t worry. The stop-loss insurance has got you covered.

Please see our Quick Guide to Understanding your Blue Cross of Idaho Balanced Funding Self-funded Health Plan for additional details.

Sales 888-462-7677 | Customer Service 800-365-2345 | Claims Inquiries 208-331-7347 or 800-627-1188

bcidaho.com

© 2017 by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association

Blue Cross of Idaho complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.

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One mission: you