Who is this product for:

  • Third Party Administrators
  • Benefits Advisors
  • HR & Benefits Leaders
  • Benefit Administrators
  • Healthcare Ins. Providers

Benefits

  • Validates Fully-Insured vs. Self-Funded Plan Design Alternatives
  • Provides Ability to Customize & Test Plan Designs and Predict Costs, Utilization, and Enrollment Results
  • Determines Best Stop-loss Insurance Configurations
  • Identifies Large Claims Exposures and Risk Mitigation Options
  • Determines Capital at Risk Amounts for Employers

Companies of practically all sizes can prudently participate in self-funded plans, and potentially save 15% or more by strengthening or introducing new plan designs.

Self-Funded Plans Capabilities

Identify Top Plans & Stop-Loss Designs

Since companies with self-funded plans have the latitude to design and manage their own healthcare plans, they can benefit from Aivante’s unique ability to determine the right plan designs, stop-loss coverage levels, capital at risk, high claims exposures, and the economic value of coverage levels vs. premium costs.

Generates Highly Accurate Projections

Projecting claims accurately is critical for self-funded plans.  Aivante utilizes advanced machine learning, healthcare-tuned algorithms, and big data to construct claim expense projections.  Since the company is responsible for paying claims in self-insured plans, it is imperative to get highly accurate expense projections so stop-loss and other risk management actions can be customized and implemented.

Personalizes Results & Choices

Aivante can analyze any variety of self-funded plan design options and run simulations to determine the features that perform best. Aivante can customize the self-funded and stop-loss insurance plans to meet the unique and specific health care needs of a workforce (as opposed to purchasing a ‘one-size-fits-all’ insurance policy).

Improves Bottom Line Results

Aivante analyzes, designs, and tests different self-funded plan configurations and financial results to help companies significantly reduce their health care costs, and improve participants’ health. Aivante can conduct an endless number of “what-if” simulations to test, price, and configure self-funded and stop-loss plan designs and coverage terms that provide maximum economic value.

Leverages Rich Data + Big Data

Each company has its own unique employee demographics, financial situation, and risk tolerance. Aivante uses both national “All Payers” claims data and company claims data to determine a company’s projected claim volume and high claim risks. Aivante integrates clinical quality data, demographic data, and healthcare plan coverage data to construct highly tailored plan design recommendations.

Predicts Future Solution Pathways

Aivante can validate self-funded vs. fully-insured program designs. Aivante can assist companies in tailoring stop-loss policy specifications that meet specific company financial needs and risk concerns. Aivante can determine the best economic value points between stop-loss premium expenses and capital at risk liabilities.