Balanced Funding

Unlike traditional fully insured plans, Balanced Funding combines fixed monthly payments with Administrative Services Only (ASO) benefits from Highmark — and adds stop-loss insurance* to protect your cash flow.

How Balanced Funding Works

First, you'll open a specially designated bank account. You will deposit the same amount of money into this account every month.

How much? Here's the formula:

Maximum Claims Liability
That's the most we think your claims will cost per month.

+

Administration Fees
What you pay for having us process your claims.

+

Stop-Loss Premium*
Protection against large or numerous claims.

x

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.

Get money back

Get money back

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.

Is Balanced Funding right for my business?

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.

Let's talk about Balanced Funding

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.