Self-funded health insurance premium is composed of employer, brokerage, administration, healthcare delivery, claims reserve, and stop loss.
We improve gross profit through our use of technology in health plan administration and high-quality healthcare delivery partners to produce better population health outcomes which results in medical claims which are lower than the reserve and stop loss claims which are lower than expected.
Our technology partner has decades of experience in creation, integration, configuration, and implementation of solutions for healthcare.
We leverage the cloud and hardware by scaling solutions as necessary and only when necessary for integrations, configurations, and implementations and machine learning (“Artificial Intelligence” or “AI”) solutions using health insurance claims data which helps mitigate risk.
Our insurance company interest incorporates existing proprietary healthcare technology with claims data for informed underwriting of stop loss and indemnity.
Value Proposition
The three largest expenses and how to address them:
Payroll:
Staffing company with Professional Employer Organization
Benefits:
Self-funded health insurance lowers costs and improves outcomes as well as provides a retirement plan through partially funded Health Savings Account
Taxes:
Disease management program to reduce claims with payroll tax advantages for both employer and employee
Overview of the Self-Funded
Health Plans:
We provide self-funded health plans which include:
Substantially lower rates (including immediate savings of 18%premium tax) and better outcomes than fully insured health plans through consumer-driven, value-based healthcare
No copay, no coinsurance
100% coverage above deductible
Partially funded Health Savings Account
Disease management program with payroll tax advantages
Patient claims credit financing
Risk transfer through our insurance company interest
Model of Quality and Savings:
Improvement in Quality results in Savings which drives Margin Opportunity to capture margin from health insurance premium in various ways:
Insurance Broker
Staffing / Professional Employer Organization (PEO) Structure
Third Party Administrator (TPA)
Healthcare Delivery – spend some more money here
Claims Fund – save much more money here
Stop Loss – save much more money here
Better Healthcare Delivery reduces chronic disease which reduces medical claims which drives the greatest margin capture available through the largest components of the premium dollar, the Claims Fund and the Stop Loss.
Business Traction:
Professional Employer Organization in Florida with 3,600 lives.
List item
Third-Party Administrator in Texas to support and help grow adoption of our plans.
Relationships with distribution partners which includes a military veteran benefit program.
Relationships with providers and hospitals in Oklahoma and Texas for networks.
Decades of experience in health plan brokerage, healthcare technology, healthcare plan administration, healthcare delivery, fintech, and insurance.
Decades of experience in healthcare technology with patented solutions built requiring only integration, configuration, and implementation.
Interest in insurance company to transfer risk and capture more margin.
Competitive Landscape &
Our Advantages:
Existing state marketplace and small group employer solutions use the fully insured business model and are much more expensive
Small group employers and sole proprietors have no readily available turnkey solution for self-funded plans
Self-funded plans deliver better outcomes at a much lower cost than fully insured plans
Scalability:
Why Small group employers and sole proprietors are desperate for a lower cost solution to health insurance, one of their largest expenses, and now need a retirement plan solution due to state mandates.
How Our turnkey solution is lower cost even when partially funding Health Savings Accounts which solves both problems for employers, and we transfer risk to our insurance company.
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