Self-Funded Health Insurance

Offering complete employee benefit solutions.

Partner with NIPC, Self-Funded Health Insurance,
ABOUT Pacific Northwest Benefits

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Pacific Northwest Benefits is a national Managing General Agency that serves as a leading resource in group health alternative funding programs for the small to mid-size employer community. Our alternative funded group health benefit solutions are designed for groups with 2 - 500 employees.


Why insurance is important for businesses.

Your business has one of the most important commodities on the planet – its people. Your employees are the very lifeblood of your business, and it’s important that any business take the time to make sure that its employees are protected and that they are satisfied.

Insurance is one of the main things employees today expect, and as such it’s important that you find a program that offers them the right coverage. Self-funded health insurance is one of the best options you can choose, offering you lower rates while still giving your employees the kind of ERISA insurance they need.

Alternative Funding For Health Coverage

We take pride in offering clients a variety of self-funded health insurance plan options for their employees. Our plans are hand selected and designed to be offered to employers with two or more employees. We offer alternative funding for ERISA based reinsurance policies that can help an employer like you bring ACA compliance and full health coverage together for your team of employees.

Instead of just working with a single insurance company, we deliver a wholesale marketplace to our broker partners then they can work with you to choose the self-funded health insurance plans that fit your needs the best. You’ll be able to find the right plan for your business and give your team the coverage that actually works for them – not something that exists only to give you ACA compliance. These are self-funded health insurance plans that actually help your employees!

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Self-funded Health Plans for Oroville, WA Small Business

As if there weren’t enough questions surrounding the type of health insurance plans you offer your employees, there’s also the question of how to best fund the program. Fully insured, self-funded, and level-funded health plans can be found throughout every industry, but small businesses tend to face more funding challenges with health insurance than their larger counterparts.

While they aren’t required by law to offer healthcare to their employees, many Oroville, WA small businesses (as defined by the ACA) nevertheless feel inclined to do so. Some choose to do it simply because they want to take care of their employees, while others do it to strengthen their recruitment and retention strategies. Of course, many employers do it for all three reasons.

Regardless of their intentions, employers who offer healthcare to their workforce know the cold, hard facts: health insurance is still ranked among the most important factors for potential employees in a compensation package. Job-seekers see how volatile the individual marketplace is and understand that the most reliable and cost-efficient way to obtain healthcare is still through an employer.

Fully-Insured Health Plans vs. Level-Funded Health Plans

Because fully-funded health insurance plans tend to be expensive for small businesses, many are turning to level-funded health plans, which blend the economic advantages of self-funding with the financial predictability of fully-funded plans. (Author: Jeff Griffin-JP Griffin Group 2018)

With group self-funded health coverage, the risk factors are spread out throughout the group – an individual who is diabetic’s health risks are offset by another member who may never end up using the health plan. This means that those who may have been uninsurable on their own can actually get a policy that works for them. With risks spread out, the overall cost of coverage drops dramatically.

Traditional Fully Funded Health Plan in a Nutshell...

  • In a fully insured plan, you pay your premium regardless of whether or not you even use your health plan. The insurance company keeps all money paid to them. Usually comes with an automatic rate increase from year to year.
  • In a level-funded health plan, you pay your premium and if your group has a low claims year, you get money back instead of the insurance company keeping it! There are no automatic rate increases.

Level funded health plans also provide Oroville, WA employers with far more flexibility in plan design and are exempt from some ACA regulations. Additionally, level-funded plans give employers access to invaluable data which can inform plan design, such as claims information, unit cost of healthcare statistics, utilization frequency, and prescription data that a fully insured plan carrier will not provide.

Why hasn’t my current broker told me about level-funded health plans?

Good question! Why haven’t they? It’s important that you as business owner understand ALL your options available! Level-funded plans are more complex, and many brokers serving small-group clients have not been trained on their structure, implementation and costs. Another reason is the momentum of fully insured small-group plans. For many brokers, it is just easier to roll their existing, or fully insured plan, forward another year. This isn’t always to the benefit of the broker, not the business owner!

While a level-funded health plan might not be a good fit for your business, it’s always the first place we start at Pacific Northwest Benefits. We look at ALL options both fully-insured and level-funded to insure you’re getting the best coverage at the best price for you and your Oroville, WA employees!

So, the question is why not explore a level-funded plan? With savings of up to 40 percent, protection against extraordinary costs, and the ability to fall back on a fully insured plan, there is very little reason not to do so.

Jason Brown

Emily Rimestad

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How Self-Funded Health Insurance Plans Work

The first step to better coverage for your employees is to understand just what self-funded health insurance is. This is a type of ERISA based reinsurance policy that allows groups to take more control over their insurance.

With a self-funded health insurance plan , your monthly payments are placed into an account that is set up specifically for your insurance policy. Then, as employees file claims the funds are withdrawn directly from that account. This is where the ‘self-funded’ aspect comes into play – instead of paying an insurance provider to keep your team fully covered, you essentially fund the medical costs yourself. The insurance provider still receives a fee, but those costs are simply for the administrative work of maintaining your account.

Group Self-Funded Health Coverage

Additionally, these types of self-funded health plans are generally group insurance plans. Group coverage means that individuals don’t have to pay specifically for their coverage. In a traditional single person insurance policy, the individual will be given charges and coverage based on their age, their weight, and their existing health. This means that someone with diabetes or someone who is older or overweight could pay far more for insurance than someone young and healthy.

With group self-funded health coverage, the risk factors are spread out throughout the group – an individual who is diabetic’s health risks are offset by another member who may never end up using the health plan. This means that those who may have been uninsurable on their own can actually get a policy that works for them. With risks spread out, the overall cost of coverage drops dramatically.

Cost Basics

The specific cost of what alternative funding will cost you when you file for coverage largely depends on the employee demographics of your business. The insurance company will begin by looking at factors that impact healthcare needs including things like:

  • Number of members to be covered by the policy
  • Age and gender of members
  • Health issues already present and how they could impact your future claims fund
  • Risk factors related to what type of business you have

Since you’re providing self-funded health care to a group of people at your business, you’re able to mitigate risks and lower overall costs. You’ll get an accurate estimate as to what your risk level and your costs should be, and then have that applied to your policy. Over time, the policy costs can be adjusted at renewal if it’s shown that you are paying too much or too little.

Benefits Of Our Self-Funded Group Insurance Plans

There are several key reasons that opting to use a self-funded health insurance plan is a better option for your business. Thanks to the structure of alternative funding, your business is taking on the majority of the risk related to offering health coverage to your employees. This means that you enjoy several benefits including the following.

Lower Costs – Since you’re taking over the majority of the financial burden in a self-funded health insurance plan, you are able to get lower overall rates. Insurance companies generally charge based on the amount of risk that they face by providing insurance to someone or to a group. When you take over funding of the insurance, they have much less risk. This translates to much less overall cost to you.

More Flexibility – We offer self-funded health insurance that can be fully built for your business and your employees. We know that every business is different. That’s why each client is able to select a plan that fits their needs. This can include adding coverage like dental or vision, and adjusting premiums, co-pays, and coverage amounts can all have an impact on the level of coverage as well as the final costs. This flexibility ensures that you can get a self-funded health insurance plan that fits your exact needs.

With self-funded health insurance, your monthly payments are actually placed into a bank account that is then used by employees when they file a claim, use a co-pay, and more. At the end of the year, if there are additional funds left remaining in the account than businesses will likely get a refund, depending upon the product and carrier. Some of the extra funds are given to the insurance company to cover administrative costs, but the remainder are returned to your business or held to be reinvested into your renewal for the next plan year. The specific amounts of the split will vary based on your policy and the carrier selected, but this extra cash at the end of the year can make a major difference in your annual budget and provide additional cashflow when you need it.

ACA Compliance – Not all businesses are required to have insurance in place to maintain ACA compliance. But, offering one of our self-funded health plans allows you to ensure that you are fully compliant and have nothing to worry about.

Happier Employees – All employees today expect to have some form of benefits when they join a team. This applies to your workers as well, and health insurance is one of the main things that employees look for when choosing a company to work for. When you have a good self-funded health insurance plan in place, you boost company morale and keep your employees happier. This can make a big difference in productivity, turnover, and more.

Simply put, the right self-funded health insurance can have a major impact on your company’s future. We take pride in offering self-funded health insurance plans that give our clients exactly what they need, when they need it. If you’re looking for a way to give your team health, vision, and dental coverage, this is an option that can help.

Self funded Insurance Performance,

How Your Monthly Payment is Used

Once you find your ERISA based self-funded health insurance plan, we start processing your payments and applying them in three different areas:

  • Aggregate and specific stop loss costs are applied to the premium
  • Costs are delivered to pay for administrative expenses
  • Funds are deposited into the Aggregate claim liability account to be used when needed

With our lower costs through alternative funding, we ensure that your employees get the protection they need without struggling to find an option that fits into your budget.

A Better Insurance For Your Team

If you’re looking for a way to give your employees health coverage that they can actually use, our Self-funded health insurance plans are well worth taking a look at. With lower overall costs and the ability to customize coverages to fit your needs and your budget, it’s a solution that offers a lot of advantages to employers.

Contact one of our team members today to discuss your business and its overall needs and plans. We’ll help you get ACA compliance and find the ERISA based insurance plan that matches up with your goals. Better coverage is closer than you might think.

Risk-free for the Sponsoring Employer

By partnering with Pacific Northwest Benefits, you will have access to a unique level-funded platform which can help shape and change the employee benefit space in your area. By focusing on employee engagement through wellness, cost control strategies and consumer driven approaches, is truly looking to make a difference in the health insurance space.

  • “The unique formula of wellness incentives with Lifestyle Health Plans was the missing link necessary to get our employees engaged in a wellness program. It’s about time that someone figured out how to get employees engaged in improving their health to help lower our healthcare costs.”

  • “We’ve tried out level-funded plans before but this Lifestyle Health Plans is different. With Lifestyle Wellness, we have a launch-ready wellness program that we’re not having to staff up for. It really is a game changer for us.”