Page 19 - IVX Health
P. 19
Funding Analysis
Administrative issues
Administrative issue Self-funded Fully insured
Claims payment Variable cost: Plan funds claims on a weekly/monthly wire Fixed monthly cost to plan.
transfer.
Fixed cost Administrative fee and stop-loss premiums. Monthly fully insured rate.
State mandates Governed by ERISA. Does not have to comply with state Plan must comply with all insurance mandates of situs state.
mandates.
Stop-loss/pooling Must purchase individual and aggregate stop-loss coverage Incorporated into fully insured rates.
from outside vendors or bundle with carrier/TPA.
SPDs Carrier TPA will still typically provide content of SPD, but plan Carrier designs and sends SPDs.
sponsor must send/post SPDs.
Taxes State taxes and ACA excise tax do not apply. Include applicable state taxes and ACA excise tax.
Compliance notices Plan sponsor must send out notices. Carrier sends out most notices to employees.
Plan design Flexibility on the plan designs and number/type of offerings Carrier limits plan designs and number of offerings.
(limited by vendor system capabilities).
IVX Health — Lockton Total Rewards Practice Overview 19 Lockton Companies
Administrative issues
Administrative issue Self-funded Fully insured
Claims payment Variable cost: Plan funds claims on a weekly/monthly wire Fixed monthly cost to plan.
transfer.
Fixed cost Administrative fee and stop-loss premiums. Monthly fully insured rate.
State mandates Governed by ERISA. Does not have to comply with state Plan must comply with all insurance mandates of situs state.
mandates.
Stop-loss/pooling Must purchase individual and aggregate stop-loss coverage Incorporated into fully insured rates.
from outside vendors or bundle with carrier/TPA.
SPDs Carrier TPA will still typically provide content of SPD, but plan Carrier designs and sends SPDs.
sponsor must send/post SPDs.
Taxes State taxes and ACA excise tax do not apply. Include applicable state taxes and ACA excise tax.
Compliance notices Plan sponsor must send out notices. Carrier sends out most notices to employees.
Plan design Flexibility on the plan designs and number/type of offerings Carrier limits plan designs and number of offerings.
(limited by vendor system capabilities).
IVX Health — Lockton Total Rewards Practice Overview 19 Lockton Companies
