
At Matrix Insurance Agency, we offer a range of group medical solutions tailored to meet your business needs.
Whether you prefer the stability of a Fully Funded plan, the balance of risk and savings in a Level Funded plan, or the flexibility and control of a Self Funded plan, we help you navigate the complexities of healthcare coverage. Our goal is to provide options that align with your company s goals, balancing cost efficiency, control, and risk, so you can make the best choice for your workforce
A fully funded health plan, also known as a fully insured health plan, is a group health insurance plan where the employer pays premiums to an insurance company for coverage.
The insurance company then takes on the financial risk of providing coverage and administering the plan. The insurance company is responsible for state insurance regulations and oversight. The upside is that when an employee has a medical claim, the insurance company is responsible for paying the bills, not the employer. The downside is the insurance company determines the premium amount and increases. In the small company health plans, the benefit coverages and the premiums are fixed and non negotiable.
The employer pays a fixed monthly amount, which includes a portion for expected claims, stop-loss insurance, and administrative costs. The employer takes on some financial risk, but this risk is capped by the stop-loss insurance. Typically, a third-party administrator (TPA) manages claims processing and other administrative tasks. The employer has more control over the plan design compared to a fully funded plan, and usually the premium is lower than the fully funded plan.
In the self funded health plan, the employer acts as the insurer and pays claims from their own bank account. The employer typically sets aside funds to cover anticipated healthcare claims and may purchase stop-loss insurance to protect against extraordinarily high claims. The employer is responsible for the plan administration in-house or hire a third-party administrator (TPA) to manage claims processing and other administrative tasks. Self-funded plans can be more flexible and allow employers to save on profit margins by avoiding insurance company expenses. However, self-funded plans are also riskier and unorthodox than fully funded plans because the risks can vary from month to month.
How to get started
Getting started with Matrix Insurance Agency is easy! Contact us to schedule a consultation where we will assess your needs and tailor our services to fit your organization. From there, we’ll guide you through the setup process, ensuring a smooth transition and effective management of your benefits programs.
Initial Consultation
Let’s have a conversation to understand what your group looks like and what your goals and needs are for your benefits package.
Solution Analysis
We take the information we gathered from you and compare it against multiple insurance options to source the best plan for your group.
Plan Selection
Armed with information and options, we’ll help guide you on the best plan selection to create the program you have envisioned for your employees.