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Insights on Group Health Insurance

Plain-English guidance on employee benefits, compliance, and controlling costs, from the PCI Solutions team in Houston.

129 articles

Group Health Insurance

What Is a Level-Funded Health Plan?

A level-funded health plan is a self-funded employer health plan packaged with regular monthly payments for expected claims, administration and stop-loss insurance. It can make budgeting easier, but it is not the same as buying fully insured coverage. The employer retains plan responsibilities and contract-dependent financial exposure.

Broker Strengths

Stop-Loss Insurance for Small Businesses: Specific vs. Aggregate

Stop-loss insurance helps a self-funded employer manage unusually high eligible health claims by reimbursing amounts above policy attachment points. Specific coverage addresses one person’s claims; aggregate coverage addresses the group’s total eligible claims. Stop-loss protects the employer, not employees directly, and it does not eliminate exclusions, reimbursement delays or every financial responsibility.

Employee Benefits

What Is a TPA in Health Insurance? Roles and Funding

A third-party administrator (TPA) performs contracted administrative work for a health plan, such as processing claims, maintaining eligibility and supporting members. A TPA is not automatically the insurer or the source of claim funding. In a self-funded arrangement, the employer generally funds covered claims while the TPA administers them under the plan's terms.