Funding options

To help employer groups manage costs of providing benefits to their employees and dependents, we have several program options to manage risk and costs.

Fully insured 

With fully insured funding, Moda Health assumes the entire risk for your client. Your client pays a fixed rate for the contract period, and there’s no after-the-fact settlement with the account. If your client is in a deficit position, the deficit is forgiven. If your client is in a surplus position, we retain the surplus and will offset any surpluses and deficits between your employer group contracts.
 

Self-insured/administrative services only (ASO)

ASO may be attractive to your clients if they seek flexible and customizable benefit platform allows for total customization. With this option we can provide customizable network options with high-quality local, regional and national provider networks, evidence-based medical and benefit management, and integrated stop-loss options.

With each plan we can provide additional access to wellness programs and health coaching and Employee Assistance Program

All our plans offer online tools for employers and their employees.

Equal Funding option

Moda Health is proud to offer Equal Funding as an option for employers who value cost control and transparency when purchasing a health plan. With Equal Funding, you get greater financial transparency while still offering your client's employees a wide range of benefits and the support to get the most out of them.

How Equal Funding works

Moda Health’s Equal Funding plan allows employers to pay for their maximum exposure over 12 predictable monthly payments. Once the policy period ends, if there is a surplus position, an administrative fee credit will be applied to the following policy year. The plan contains three components:

• A self-funded medical plan, which covers medical services and pharmacy expenses for your client's employees
• An agreement with Moda Health that provides third-party administration for claims processing, billing, customer service and other administrative services
• A stop-loss insurance policy from Moda Health that helps protect employers from large catastrophic claims by a covered individual(s), and provides overall protection if combined medical and pharmacy claims exceed the expected annual limit
  
  

Why Equal Funding is different

With Equal Funding, if covered claims are higher than expected, the stop-loss insurance policy will cover them. However, if healthcare claims are lower than expected, employers will receive a credit toward the next plan year's administrative fees. The premium equivalent includes the cost of estimated healthcare claims and fixed-cost items (administrative fees and stop-loss insurance premiums). This calculated amount is considered employers' “maximum liability” to eliminate surprises at the end of the year. A portion of the monthly payments will go toward a claims funding account, which covers employees’ eligible claims. At the end of the year, the claims funding payments will be compared with the actual claims costs. If actual claims costs for the year are less than expected, the plan has a surplus.


Learn more by downloading our Equal Funding brochure.