Aetna Funding Advantage (AFA) plans are self-funded, which means that the employer provides the benefits coverage. The employer is simply provided with administrative services and stop loss insurance coverage by Aetna Life Insurance Company.
How is AFA funded?
In general, the Tribe/Consortium receives monies in an AFA in an amount equal to the amount it is eligible to receive under section 106 of Pub. L. 93-638. The quantity of funding must be contingent on the availability and level of Congressional appropriations for that program or activity at the bureau.
What is Aetna Funding Advantage plan?
What is Aetna Funding Advantage, and how does it work? Aetna Funding Advantage is a self-funded insurance plan tailored to small enterprises. It provides a single, predictable monthly payment, the ability to recover money back if claims are lower than predicted, and the safety net of stop-loss insurance if claims are higher than projected.
What is the difference between fully insured and self-funded?
Employer purchases insurance from an insurance company in a fully insured plan. Employees receive health benefits directly from the business in a self-funded plan. The risk of providing health coverage for covered events is assumed by the insurance company.
Is Aetna self-funded?
Self-funding allows for more cost control. You pay for your employees’ health-care bills, and we safeguard you from unforeseen costs with an Aetna Funding Advantage plan. Administration expenses, stop-loss premiums, and claims responsibility charges are all included in one monthly payment.
With Marketplace plans, you get no employer contribution
Your employer pays a portion of your monthly premium in most job-based health insurance plans. The employer will not contribute to your premiums if you enroll in a Marketplace plan instead. When comparing your job-based insurance to Marketplace plans, keep this in mind.
You probably wonât qualify for Marketplace savings
If you decline a job-based insurance offer and instead enroll in a Marketplace plan, you are unlikely to qualify for a premium tax credit or other savings, even if your salary qualifies you otherwise.
Even if you don’t enroll in your employer’s insurance, you’ll have to pay full price for a Marketplace plan.
How do I know if my health insurance is self-funded?
You may have a self-funded plan if you get insurance through your (or your parents’) job or education, including if you work for the government.
This is significant because, if your plan is self-funded and includes a coverage exclusion or limitation, it may be more productive to discuss the exclusion with your employer rather than the health insurance company that administers the plan.
“How do I figure out if my plan is self-funded?”
Asking your human resources department whether your employee plan is self-funded or fully insured is the simplest method to find out. Another option is to look through your plan brochure for the details.
Watch this video to learn how to tell if your plan is self-funded or fully insured (video source: Transcend Legal)
“My plan is self-funded, what now?
Get assistance with self-funded insurance plans and transitional health care, such as:
- A letter template to your company or school requesting that an exclusion from a self-funded plan be removed.
- A preauthorization letter template to send to a health plan administrator.
What does it mean when a company self insures?
Rather than paying an insurance carrier to pay for medical, dental, and vision claims, we pay for them ourselves, employing a third-party administrator to process the claims on our behalf. The insurance coverage is unchanged.
Whats better PPO or HMO?
Monthly premiums for HMO plans are often lower. You can also anticipate lower out-of-pocket expenses. PPOs feature higher monthly premiums in exchange for the ability to access in-network and out-of-network physicians without requiring a referral. A PPO plan’s out-of-pocket medical costs can also be greater.