Health Insurance Solutions for Smarter Coverage

Franklin Benefits Group helps clients evaluate fully insured, level-funded, self-funded, and reference-based pricing health plans. We also provide guidance for Health Reimbursement Arrangements, Health Savings Account-qualified plans, and ICHRA administration. Recommendations account for employer budget, workforce needs, desired plan flexibility, risk tolerance, and the value of benefits offered to employees and their families.

With a fully insured plan, an employer pays a set premium and the carrier assumes the financial risk for covered claims. With self-funding, the employer pays employee claims directly and assumes more risk, typically using stop-loss insurance for large claims. Self-funded plans can offer flexibility and lower overhead, but require careful financial planning and administration.

Level funding is a form of self-funding designed to offer more predictable monthly costs. The employer pays a fixed monthly amount for expected claims, administration, and stop-loss coverage during the plan year. If claims are lower than expected, a surplus may be returned according to the plan terms. It can be a useful alternative for employers seeking predictable budgeting with potential savings.

Reference-based pricing is a cost-containment approach that sets a maximum covered amount for selected shoppable services, such as lab tests, prescriptions, or joint replacements. Employees can compare price and quality before receiving care. If they choose a provider charging more than the established limit, they may be responsible for the difference, making employee education especially important.

A Health Reimbursement Arrangement is an employer-funded arrangement often paired with a high-deductible health plan. The employer determines how much of an eligible deductible or healthcare expense to reimburse. Unlike an HSA, the HRA is owned by the employer. Subject to the arrangement terms, unused funds generally remain with or return to the employer rather than the employee.

Employees and employers may contribute to an HSA when the employee is enrolled in a qualified high-deductible health plan and meets applicable eligibility requirements. The HSA is owned by the employee, and eligible contributions receive tax advantages under federal rules. Unlike many reimbursement arrangements, unused HSA balances generally roll over year to year and remain with the account holder.

Yes. An Individual Coverage Health Reimbursement Arrangement lets an employer reimburse eligible employees for qualifying individual health insurance premiums and medical expenses, subject to plan rules. Employers can vary reimbursement amounts by permitted employee classes, family size, and age within applicable limits. Generally, the same employee class cannot be offered both a traditional group health plan and an ICHRA.

Yes. Employers can generally appoint Franklin Benefits Group as Broker of Record during the plan year without waiting for renewal or changing their existing health plan. A Broker of Record letter allows the team to conduct market analysis, obtain quotes from multiple carriers, review plan design, and provide ongoing service while the current coverage remains in place.