Priority Health Optimized Level Funding Option (OLFO)

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Great service, easy underwriting, amazing plan designs and networks to help you win and retain business!

EASY UNDERWRITING!

Groups with 5 or more enrolled MEMBERS can be underwritten with NO HEALTH STATEMENTS!! 

That means a very small group can see if they would be a fit for Level Funding without the requirement of individual medical questionnaires. 

Most agents go straight to ACA plans for small groups. Why not take the time to see if a group could do better through level funding?

Why Level Funding?

The ACA addresses fully insured plans. Level funding is modified self-funding and therefore governed by ERISA. This affords these groups the opportunity to step out of certain ACA requirements such as:

  1. Member level rating
  2. Essential Health Benefits (including pediatric dental)
  3. Community Rating (level funded plans are underwritten based on health history)
    • Renewals are based on the experience of the group
    • These groups have access to their specific experience; this is not possible in ACA fully insured plans


Level Funding requires a bit more explanation on the agent’s part but the opportunity for better rates, clarity and ease of administration with tiered rates could set you aside from your competition.


It takes work to sell level funding, we understand that. But with Priority Health, you have a Michigan grown brand with a great network and impeccable, local service. You can WIN BUSINESS with Priority Health, Optimized Level Funding Option and Benefit Profiles Inc!

THE NETWORK OPPORTUNITY!

HMO, POS good for the entire lower peninsula! Priority Health’s HMO requires a PCP designation but NO REFERRALS IN NETWORK!

Concerned about HMO only? You are allowed to offer the HMO and the POS side by side in a plan!

An "Upside Only" Level Funding Option

Employers with 2-50 enrolled employees are eligible for optimized level funding.

Employers can select plans from the current small business ACA plan menu with the exception of HRA plans.

Priority’s unique take on HSA plans are best in class in the market

  • H.S.A. plans with a deductible of $3000 or greater have an embedded deductible, lower deductible plans have an aggregate deductible
  • $10 or less virtual care
  • 100% coverage for allergy treatment and testing
  • Simple lab and x-ray before deductible (except on H.S.A and PriorityAssure plans)
  • Adult vision on all non-H.S.A. plans
  • H.S.A. plans provide coverage ahead of the deductible for certain IRS allowed chronic conditions

Value Added Benefits

  • Assist America
  • Mobile app
  • Behavioral health support
  • Cost estimator and priority rewards
  • Priority mom
  • Priority baby
  • Fitness center discounts
  • Diabetes management and prevention
  • Wellbeing HUB
  • Benefit hub
  • TruHearing
  • COBRA administration through iSolved (FREE)
  • HSA administration through Health Equity (FREE)

To learn more about PH’s OLFO product and the services we offer surrounding the sales and service, contact Dominic or Collin and we can schedule a training.

How it works

01

Your clients pay a fixed monthly amount to cover the costs of administration, stop-loss and claims funding.

02

Priority Health uses the money as needed to pay claims.

03

At the end of the plan year, the account is reconciled for funds in excess of projected claims expense. The group is not required to pay Priority Health back if there is a deficit at the end of the plan year.

04

If there is a surplus, the employer will receive 50% of the surplus.

Benefits of an optimized level funded plan

  • Lower, stable monthly fees
    • You’ll have stable monthly costs that make it easier for you to budget for health care, at a lower rate than a fully funded plan.
  • Balance of flexibility and risk
    • Optimized level funded plans combine the flexibility of a self-funded plan with lower risk characteristics of a fully funded plan.
  • Opportunity for money back
    • Optimized level funded plans give your clients an opportunity to get money back at the end of the contract year if the amount of pre-funded claims paid exceeds the cost of claims experienced

An “upside only” level funding option

Employers with 2-50 enrolled employees are eligible for optimized level funding.

Employers can select plans from the current small business ACA plan menu with the exception of HRA plans.

Underwriting Considerations

    1. Open to Michigan (lower peninsula only) domiciled groups with 2-50 full time eligible employees,
      •  minimum hours worked may be set as low as 17.5 hours
    2. No Cannabis related businesses including, dispensaries, grow houses and product transportation services.
    3. Participation
      •  75% of those without coverage elsewhere (individual, Medicare, Medicaid, parental coverage, spousal coverage, Tri-care, etc.) must enroll
      • If a group appears to have low participation, please confirm that those not enrolling have other coverage.
    4. Medical underwriting
      • Groups with 5 or more enrolled MEMBERS can be underwritten through the CURV tool.  NO HEALTH STATEMENTS!!
    5.  Out of state employees
      •  Rule, limited to 35% of enrolled employees.
      • Reality, the fewer out of state the better, generally a couple of out of state employees is ok depending on where they live.  (High cost states like, NY, MA, PA, FL, TX, CA, IL generally do not bode well for the rate)
    6. H.R.A. and GAP/WRAP plans are not allowed
    7. Groups may have 2 plans, must have at least 10 enrolled employees, and at least 25% must enroll in one plan
    8.  Retirees are NOT eligible for coverage

Quoting Requirements

Group information

  1. Required
    • Effective date
    • Name
    • Address
    • Current carrier
    • Desired plan designs
  2. Optional (and helpful) 
    • invoice, 
    • renewal, 
    • benefit summaries, etc.

Member level census (Do NOT include waivers)

  1. First name
  2. Last name
  3. DOB
  4. Gender
  5. Home zip code
  6. Status (employee, spouse, or child)
  7. Enrollment status
    • Single
    • Ee+spouse
    • Ee+ child(ren)
    • Family (EE+SP+ 1 or more children)

Quoting Requirements

Group information

  1. Required
    • Effective date
    • Name
    • Address
    • Current carrier
    • Desired plan designs
  2. Optional (and helpful) 
    • invoice, 
    • renewal, 
    • benefit summaries, etc.

Member level census (Do NOT include waivers)

  1. First name
  2. Last name
  3. DOB
  4. Gender
  5. Home zip code
  6. Status (employee, spouse, or child)
  7. Enrollment status
    • Single
    • Ee+spouse
    • Ee+ child(ren)
    • Family (EE+SP+ 1 or more children)

Dominic Siciliano

President, Agent Consultant

Over his 18 years in the benefits business Dominic has worked in the Medicare Advantage, small group Blue Cross medical, ancillary GA and large group benefit admin space here in Michigan. His parents and biggest influences, Patricia Siciliano and John McClain, instilled in him the key pillar to GA benefits business—relationships with agents and carriers. Dominic has served as the NABIP West Michigan President twice. He’s run the golf outing several years going and he served at the Legislative Co Chair for the State Board during the passing of PPACA. His Friday morning classes, Employee Benefits 101, is highly regarded in the industry as a practical, real world introduction to the business for new folks. In short, he is passionate about our business and about seeing agents succeed. 

Dominic loves golf and basketball but as he gets older, golf more. He’s a Western grad but a State fan! He most enjoys spending time with wife Janelle and four children outdoors and Up North! From the very early days of BPI when it was just him and Lena in a tiny little office, he hasn’t changed, it’s about getting the job done for agents.