Your premiums include two components: administrative fees and medical expenses. The monthly premium will always include administrative fees. Depending on the size of your company, there may be options for your employees to assume part or all of their medical expense.

Fully Insured
Your group’s entire medical expense risk is assumed by SelectHealth. Your group pays a fixed premium every month to cover administrative fees and medical expenses. This funding arrangement is available to large employers.

Contingently Funded
This provides the option to assume a limited amount of medical expense risk. Your group pays a fixed premium every month but never pays more than the maximum liability. A final settlement occurs during the 17th month, at which time you may be eligible to receive a premium refund if you have low medical expenses during the plan year. This is only available to groups with 100+ enrolled employees.

Self Funding
A self-funded arrangement allows your group to assume the medical expense risk. Your group will be responsible for administrative fees and incurred claims up to a maximum liability (usually 20 percent higher than expected claims). This option is only available to groups with 200+ enrolled employees.

Alternative Funding
This is a fully insured funding arrangement that provides greater cash flow advantages and lower risk exposure than self funding. Your group has the option to assume partial or limited medical expense risk, while still providing a mechanism for protection against high monthly claims’ exposure. Each month, your group will pay the administrative fees for the current month and the variable medical expense (based on claim activity) for the previous month. This option is only available to groups with 100+ enrolled employees.