First, you'll open a specially designated bank account. You will deposit the same amount of money into this account every month.
Maximum Claims Liability
That's the most we think your claims will cost per month.
What you pay for having us process your claims.
Protection against large or numerous claims.
The number of employees you have
The amount you deposit in your account per month
The amount due will draw directly from your designated bank account on the specified date. If it's less than the money you've set aside, we'll only deduct what you owe. The rest stays in your account.
If it's more than what you’ve set aside, we only withdraw what’s available. Hopefully that never happens. But if it does, you have Stop-Loss insurance.* You will not receive an extra bill for the overage.
If there's money left over in your account when your plan year wraps up, congrats, you have a surplus. Most of those savings will come back to you. Your Highmark rep will be happy to break it down for you.
If there's money left over in your account when we settle for a given contract period, you’ll get to keep a chunk of it. Think of it as a bonus for being healthy. Highmark will retain a portion of this remainder as a deferred administrative fee.
There are three things you should consider before you sign up for this product:
Your employees' health
The healthier they are, the fewer claims they'll make and less risk to your cash flow.
The size of your workforce
This plan works best with a stable workforce. If you are planning to expand or downsize, then this may not be the best fit for you.
How much information you want
Summary reporting is great for getting insights into your employees’ health and can help you get the most from your health care dollars.
See if Balanced Funding is right for your company.
* Stop-Loss coverage is provided solely by a separate company, HM Life Insurance Company. Speak with your client manager for more information.
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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Blue Cross Blue Shield of Western New York serves eight counties in Western New York and Highmark Blue Shield of Northeastern New York serves 13 counties in Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.
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