Preferred United Plans® “Alternative Funding” (PUP AF) is a self-funded aggregate stop-loss program designed by SecureOne Benefit Administrators, its actuaries and with Companion Life Insurance Company (AM Best A+ Superior) as the Stop-Loss Carrier.
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STATES WITH PROGRAM AVAILABILITY
PPO NETWORKS
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CAPITATED FUNDING
Preferred United Plans® “Alternative Funding” is broken down as one would see under fully insured; EE, ES, EC & Family. To determine this, there are three pricing components (1). Administration Fees (2).Funding Aggregate Premium Fees and (3).Funding Claims Factor Fees
Preferred United Plans® “Alternative Funding” is broken down as one would see under fully insured; EE, ES, EC & Family. To determine this, there are three pricing components (1). Administration Fees (2).Funding Aggregate Premium Fees and (3).Funding Claims Factor Fees
PREFERRED UNITED PLANS® “ALTERNATIVE FUNDING” FEE COVERS
Implementation, Plan Documents/SPD’s, SBC’s, Networks, Banking Reconciliation, COBRA, run-out claims, administration, case management, precertification, PBM administration, Rx claims, medical claims, on-line enrollment are all included in the pricing of Preferred United Plans® “Alternative Funding”.
The Employer (Plan Sponsor) must meet the contractual obligation of the Administrative Contract with SecureOne and the stop-loss carrier, Companion Life Insurance Company, based upon the twelve (12) month terms. SecureOne bills out electronically by the 15th of each month for all Fees, Premiums, and Claims Funding which must be paid by the 1st of the month. As long as the terms of the contract are met, and required payments are received on time, should claims processed during the month exceed what is in the Employer Claims Funding account, the Employer owes nothing more. Companion Life Insurance will advance Aggregate Stop-Loss Claims Funding.
Implementation, Plan Documents/SPD’s, SBC’s, Networks, Banking Reconciliation, COBRA, run-out claims, administration, case management, precertification, PBM administration, Rx claims, medical claims, on-line enrollment are all included in the pricing of Preferred United Plans® “Alternative Funding”.
The Employer (Plan Sponsor) must meet the contractual obligation of the Administrative Contract with SecureOne and the stop-loss carrier, Companion Life Insurance Company, based upon the twelve (12) month terms. SecureOne bills out electronically by the 15th of each month for all Fees, Premiums, and Claims Funding which must be paid by the 1st of the month. As long as the terms of the contract are met, and required payments are received on time, should claims processed during the month exceed what is in the Employer Claims Funding account, the Employer owes nothing more. Companion Life Insurance will advance Aggregate Stop-Loss Claims Funding.
MONEY BACK
The Aggregate Stop-Loss contract term is a 12/18 contract. Upon the completion of the terms of the administration contract and Companion Life Insurance Company’s stop-loss contract policy with all payments having been fulfilled by the employer, an audit is conducted. Should claims paid during the terms of the contract fall short of what was collected during the terms of the agreement, the employer may be issued a refund of 100% of the difference. YES, A REFUND!
During the same time frame, should the claims paid exceed the amount collected, based upon the terms of the stop-loss contract, the employer may owe nothing.
The Aggregate Stop-Loss contract term is a 12/18 contract. Upon the completion of the terms of the administration contract and Companion Life Insurance Company’s stop-loss contract policy with all payments having been fulfilled by the employer, an audit is conducted. Should claims paid during the terms of the contract fall short of what was collected during the terms of the agreement, the employer may be issued a refund of 100% of the difference. YES, A REFUND!
During the same time frame, should the claims paid exceed the amount collected, based upon the terms of the stop-loss contract, the employer may owe nothing.
| Employers have access to: | |
| • Monthly Billing Statements | • Plan Document |
| • Summary of Benefits & Coverage (SBC) | • Financial Timetable (Real Time) |
| • Large Claimants | • EOBs |
| • Network Links | • Privacy Notices |
| • Enrollment | • Reporting |
| Members have access to: | |
| • Personal Explanation of Benefits | • Deductibles & Out of Pocket Amounts |
| • Health e-360 | • Network Links for Provider Search |
| • Summary of Benefits & Coverage (SBC) | • Healthy Newsletter |
| • Online Wellness Program | • Spanish Language Conversion |
MDLIVE - Telehealth that is provided through Preferred United Plans® "Alternative Funding"
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