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Major Medical
Major Medical

The simplicity and security of traditional fully-insured plans – plus flexibility.

The OptiMed Level Funded Major Medical Program provides consultants the flexibility to meet the diverse needs of their clients.

About This Solution

The Level Funded Plans give employers the simplicity and security of traditional fully-insured plans, plus the possibility of money back. Because health coverage shouldn’t be one-size-fits-all.

Major Medical Image

Our portfolio of Level Funded Health Plans feature deductibles as low as $500 up to $8,150. Plans include co-pay, coinsurance and HSA-compatible options. Each plan includes excess loss (stop-loss) reinsurance for both aggregate and specific claims. Monthly accommodation is provided in all plans so that an early-in-the-year claim does not drain the employer’s cash flow.

Level Funded Plans provide comprehensive medical coverage with the possibility of an end-of-year refund for good claims experience. Every dollar set aside for claims not expended during the plan year is returned to the employer. The employer may then use the funds tax-free on renewals or other employee benefits. That is a 100 percent refund of the claims fund surplus.

Why OptiMed

Reference Based Reimbursement

OptiMed Level Funded Health Plans with RBR (Reference Based Reimbursement) include claims cost management technology to:

  • Identify RBR-friendly medical practitioners
  • Address any balance billing disputes that may arise

Self-service online portal

OptiMed provides employers and plan members each their own self-service online portal for managing claims and healthcare options. Plan members, administrators, and brokers are also provided just one phone number, email and postal address for all matters related to the plan.

Licensed Staff

OptiMed provides group health brokers access to a licensed life/health sales staff to help with your level funded health plan requirements.

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Solution Details

Level Funded Major Medical Plan Features

PPO Networks & Reference Based

Reimbursement

Retrospective refund for Favorable

Claim Experience

ACA Compliant

OptiMed Advantage Benefits (optional)

AM Best A- Rated or better reinsurer

Both Specific and Aggregate Reinsurance Protection

Single Sourced Administration

Simplified GatekeeperQuestionnaire

COBRA Administration

Level Funded Major Medical Plan Features

100% Claims Reserve Refund for favorable claim experience.

PPO Networks & RBR (Reference Based Reimbursement).

Cigna or US-Rx PBM.

Both Specific and Aggregate Reinsurance Protection.

Simplified Gatekeeper Questionnaire.

Includes Telemedicine.

Includes COBRA administration.

Wellness program included.

Discount fee on nutritional weight loss program that can also reverse diabetes.

OptiMed GAP can be added to reduce employee out-of-pocket expenses.