How the program works
With the Assurant® Self-Funded Program, your maximum cost for claim expenses is determined up front and guaranteed, subject to enrollment and benefit changes. If the actual expenses are lower than the balance in your claims fund, you are refunded the difference.
- Your monthly payment includes a contribution to your claims fund. The group's claims are paid out of this fund.
- Depending on how the program is set up, the employee may have cost-sharing requirements to satisfy, such as a deductible or coinsurance, before claims are paid from your claims fund.
- The program and the claims fund are owned by you, the small business employer, and you select the features and options that best fit your group.
- There are hundreds of program design templates for you to choose from and customize, offering your employees options similar to what they might be accustomed to seeing with traditional small group fully insured plans.
- All employer-established health benefit plans are minimum essential coverage under the Affordable Care Act.
- Program template options meet minimum value.
What happens if claims are larger than expected?
Assurant Health stop-loss insurance protects your business's assets against larger-than-expected claims by covering you (through direct payments into your claims fund) if claims for the program year exceed pre-determined levels called stop-loss limits.
There are two types of stop-loss coverage:
- The aggregate stop-loss: which protects you against higher-than-expected claims incurred by your group as a whole. The aggregate limit is equal to your total contribution to the claims fund for the program year.
- The specific stop-loss: which protects against higher-than-expected claims by an individual group member, if an individual group member's claims exceed a pre-selected level called the specific limit.
Stop-loss insurance also advances money, via a deposit into your claims fund, if the claims for any given month exceed your claim fund's available balance.
Who manages the program?
Your program is managed and administered by our trusted third-party administrator, Allied Benefits Systems, Inc. (Allied). They have more than 30 years of experience in benefit management and administration services. Allied also:
- Manages your claims payments, reporting, customer service and more.
- Offers extensive online services and monthly reports that make it easy for you and your employees to access information about your program.
- Takes care of the program administration for you — so you're free to focus on your business.
- Simplifies your billing, too. One flat monthly payment3 covers everything — your claims fund contributions, stop-loss insurance premium and administrative services.
That bill is guaranteed not to change, subject to enrollment and benefit changes.