Health Access Solutions (Healthcare Coop)
SPFA members have access to the Health Access Cooperative — a member-owned healthcare cooperative built around no networks, no prior authorization, and predictable, per-incident costs instead of a traditional deductible. Members pay just $1,000 per incident, then care is covered at 100%, with preventive, dental, vision, and mental health covered at $0 before any deductible ever applies.
Everyday care is simplified through 24/7 virtual care, navigation, and lab access via Amaze Health, plus interest-free funding through medZero to cover deductibles, co-pays, and prescriptions — no credit check, no interest, no fees.
Unlike a traditional carrier, the Cooperative is member-owned, so there's no shareholder profit built into the cost of coverage. The savings are designed to go back to members.
Download the Health Access Solutions Presentation.
Medical Gap Strategies
Employer Benefits of Medical Gap Coverage with High-Deductible Health Plans (HDHPs)
Lower Overall Health Insurance Costs
• Increase major medical deductibles reduces premium rates
• Add Medical Gap coverage to fill deductibles and co-pays at a lower cost than traditional low-deductible plans
• Overall reduction in premium
Slows Annual Medical Premium Increases
• Annual medical premium increases primarily affect major medical plans, not Medical Gap insurance
• Gap insurance premiums remain relatively stable, providing cost predictability
Enhanced Employee Retention and Satisfaction
• Strategy has a perceived value of benefits to employees
• Lower premium contributions and out-of-pocket expenses improve employee financial wellness
ICHRA (Individual Coverage Health Reimbursement Account
What is ICHRA?
• Tax-free reimbursement for employees to buy individual health plans on the ACA Marketplace
• Available to businesses of any size, no contribution limits
• Customizable allowances by employee class (e.g., full-time, part-time)
Lower Costs, Higher Value
• Tax-free reimbursements maximize employee benefit value
• Simplifies administration vs. managing group plans
• Supports recruitment/retention with modern, flexible benefits
Employee Freedom
• Choose Marketplace plans tailored to individual or family needs
• Access diverse options (e.g., bronze, silver, gold plans)
• Flexibility to select preferred providers and coverage levels
Cost Savings for Employers
• Set fixed reimbursement budgets (e.g., $300-$500/month per employee)
• Avoid high group plan costs ($7,584 single/$19,276 family annually, 2024 data)
• No minimum contribution requirements, unlike group plans (50%+ premium)
Source: 2024 health insurance cost data; ACA regulations
Level Funding
What is Level Funding Health Insurance?
Level-funded health insurance is a hybrid employer-sponsored plan blending fully insured and self-insured models. Employers pay a fixed monthly amount covering administrative fees, expected claims, and stop-loss insurance to cap risk. If claims are lower than projected, employers may receive refunds; if higher, stop-loss covers excesses. It's ideal for small to mid-sized businesses transitioning from fully insured plans.
Advantages
-
Potential Cost Savings: Fixed payments can be lower than fully insured premiums; surplus refunds if claims are below expectations, reducing overall expenses.
-
Predictable Budgeting: Steady monthly costs provide financial stability, avoiding fluctuations from high claims due to stop-loss protection.
-
Medical Underwriting Benefits: Rates based on group's health history (experience rating) rather than community rates, potentially lowering costs for healthier groups.
-
Customization and Control: More flexibility in plan design and access to claims data for better cost management.
-
Tax and Fee Exemptions: Often avoids certain state taxes and fees associated with fully insured plans.
Disadvantages
-
Potential Cost Increases: High claims can lead to rate hikes in renewal years, eroding savings.
-
Medical Underwriting Risks: Requires group health assessment; unhealthy groups may face higher rates, denial, or ineligibility.
-
Administrative Complexity: More paperwork and oversight than fully insured plans, including compliance with self-funded regulations.
-
Limited Suitability: Best for stable, healthier groups; not ideal for very small or high-risk employers.
-
Refund Uncertainty: Surplus returns depend on low claims; no guarantee of savings every year.