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National General Benefits Solutions Level Funded Group Plans

National General Benefits Solutions provides small and mid-sized employers with benefits options previously only available to large employers — helping employers lower costs while providing quality benefits to their employees. They have health coverage options available in 49 states, as well as the District of Columbia.

National General Benefits Solutions is focused on providing cutting-edge benefits solutions to small and mid-sized businesses. Stop-loss insurance for National General Benefits Solutions is underwritten by National Health Insurance Company (incorporated in 1965), Integon National Insurance Company (incorporated in 1987) and Integon Indemnity Corporation (incorporated in 1946). 

National General Level Funded Group Plans - Features and Benefits

National General Level Funded group plans offer the following:

  • They take “newly minted” companies- no time requirement for being in business
  • NO Industry Exclusions
  • Group Eligibility with as few as 2 covered employees
  • 100% refund option available on unused claims dollars
  • Groups entitled to refund regardless whether they reissue
  • Teledoc available on all plans
  • Carve-out options
  • Flexible participation: Need to meet one or the other - on qualifying products
  • 50% excluding valid waiver
  • 25% including valid waivers
  • Individual Medical is a valid waiver
  • 24 hr. coverage for owners, officers, and partners
  • In-Network only plans with multiple broad national PPO networks or...
  • Reference Based Pricing options for savings of 20%+ compared to network options
  • 2-3 day underwriting if information is complete
  • Average 3-5-day implementation time to activate a group after underwriting has accepted the submission

Important Note: In many states we can write a level funded small group health plan to groups with as few as 2 covered employees. However, to really have the best chance of success with a level funded plan a group should have at least five (5) covered employees. 

National General Level Funded Health Plan Options

National General offers two primary Level Funded plan options for reimbursing healthcare providers: 

PPO Plans - National General's PPO Plans offer ultimate flexibility with a wide variety of benefit options, allowing you to custom build a plan to fit the needs of your group. These plans pay benefits for both in and out-of-network services. They offer secured network savings with access to large, national networks.

Core Value Plans - Core Value is a reference-based pricing plan, meaning it pays providers based on a multiple of the Medicare reimbursement rate (or other derived equivalent), regardless of the billed amount. This can reduce the amount paid for your employee's claims — which would save money for both you and your group’s employees. Plus, plan administration is handled for you, leaving you to focus on running your business.

About Level Funded Health Plans

As noted on our NAHP Alternative Health Plan Solutions page, Level Funded plan premiums are typically (at least) 15-20% less than the same plan design on an ACA/Obamacare, fully insured group plan. Plus, in most years with average to below average usage of the plan, there is an opportunity to receive an additional refund at the end of each plan year.

In addition to typically starting with lower monthly premiums, a Level Funded health plan can save employers more money by paying the claims of their employees with their own money instead of insurance premiums.

With a Level Funded group health plan:

  • You pay one, level (fixed) monthly premium (Just like with a fully insured ACA/Obamacare plan). You never have to pay more than this fixed amount each month.
  • Your monthly payment is split into three "buckets" to cover: 
  1. Administrative costs of your plan
  2. Stop-loss insurance and 
  3. Funding your Claims Account to pay for your employee's claims that are below the limits of your Stop-loss insurance

In most cases there are two separate Stop-loss insurance policies built in to your Level Funded plan. They protect you:

  • If any one individual plan member has large claims during the year and
  • If the overall group claims exceed the total of your Claims Account for the year.

After all claims have been paid for the plan year (after a run-out period of a set number of months), you are eligible to get back some or all of the remaining dollars in your Claims Account. When you start your plan, you choose how much you want to get back from the unused funds in your Claims Account. You can choose to get a refund check or use the money to lower your costs for the next year.

To learn more about National General's Level Funded, self-funded plans download the National General Self-Funded Brochure

National General Core Value Plans Reference Based Pricing Information

Reference Based Pricing (RBP) is a unique strategy that has been leveraged by large employers, to determine reimbursement rates to providers based on a multiple of Medicare.

Advantages of reference-based pricing are many and include:

  • Maximum cost-savings – Reference-based pricing uses fixed pricing across providers for healthcare services based on a multiple of Medicare, preventing provider pricing variances for the same services that can be as much as 500%, with no difference in quality.
  • True Provider Choice – Plan participants are eligible to receive care from any provider within the United States. There are no network restrictions.
  • Claim Advocacy – National General provides negotiation services with providers on claim amounts above the reasonable fee (known as "balance billing"), striving to retain savings on behalf of the plan. National General provides their Member Advocacy Program (MAP) team to help you resolve any/all balance billing issues with providers. See this MAP Employee ID Card Insert
  • Unique Approach for Small to Mid-Size Groups – Featuring all of the advantages of self-funded health plan designs, reference-based pricing also mitigates cost and encourages consumer knowledge of and participation in healthcare choices.
  • Increased Transparency – National General provides the use of Healthcare Bluebook, an online transparency tool, to help plan participants receive a truer picture of provider cost and quality. See this National General Healthcare Bluebook flyer. 

To learn more about National General's Core Value plans download the National General Core Value Brochure

National General Provider (PPO) Network Availability

National General works with multiple local and national Preferred Provider (PPO) networks (from Cigna Aetna and others) to pair with their Level Funded PPO plans. Availability varies by state and we will help you determine which network works best for you. 

National General Small Group Level Funded Plan Quotes

If you would like to get a group health insurance quote for your business, the first step is to download and complete our group census form here: 

US Insurance Solutions Group Census form.xls

Please email the completed form to: robtavis@ushealthinsurancesolutions.com

Schedule a Call With Me:

Once you have completed and emailed the completed census form, please go to the link above that says CALL ME to schedule a consultation on my online calendar to discuss your situation and needs so that we can come up with the BEST health plan for your company.

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