Series
Alternative and Complementary Products
Level funded sits inside a frontier that includes ICHRA, association health plans, MEWAs, PEOs, group captives, portable benefit accounts, and products not yet built. Each alternative solves a different version of the small employer coverage problem. None solves all of them. The series maps what each model requires, what it costs, where it works, and who should still be in fully insured regardless.
LFP-08.01
ICHRA Mechanics: How Individual Coverage HRAs Actually Work and Where They Break
ICHRA is a reimbursement mechanism, not a risk-bearing structure. The employer sets a monthly dollar amount. The employee buys an individual plan. The coverage outcome depends …
LFP-08.02
ICHRA and Level Funded as Complements or Substitutes: The Strategic Confusion Most TPAs Are Making
The TPA that offers both level funded and ICHRA without resolving which product serves which employer is building a portfolio that competes with itself. For some employers, ICHRA …
LFP-08.03
Association Health Plans After the 2018 Rule and Its Repeal: What Remains and What Could Return
Association health plans aggregate small employers into a pool large enough for large-group treatment, avoiding ACA small-group rules. The 2018 DOL expansion rule was challenged by …
LFP-08.04
MEWAs: The Pooling Mechanism That Could Solve the Micro-Employer Problem If the Regulation Allowed It
MEWAs solve the micro-employer actuarial problem by construction: pool 30 employers with 8 employees each and cover 240 people. The regulatory framework that governs them is among …
LFP-08.05
PEOs as a Coverage Vehicle: What Works, What Employers Surrender, and Why It Matters
The professional employer organization makes the 10-person construction firm eligible for large-employer benefits by making itself the co-employer of that firm's workers. The …
LFP-08.06
Level Funded as Supplemental Insurance: Can the Model Work as a Layer Rather Than a Foundation?
Level funded is priced and structured as primary coverage. Adapting it to wrap around an ACA marketplace plan or a direct primary care membership requires changing foundational …
LFP-08.07
Captive Insurance Structures for Small Group Benefits: The Risk-Sharing Model Gaining Traction
Group captives replace the commercial stop loss carrier with an entity the member employers own. AM Best-rated captives preserved an estimated $6.6 billion in underwriting profit …
LFP-08.08
Portable Benefits and Multi-Employer Contribution: The Legislative History and What Solving It Would Require
Twenty-seven million Americans work independently as their primary income source, with fewer than 9 percent preferring traditional employment. A portable benefits account that …
LFP-08.09
The Hybrid Models Nobody Is Building: Where the Structural Gaps and the Product Opportunities Intersect
The populations most consistently underserved by both level funded and its alternatives are not underserved for lack of attention. They are underserved because the products that …
LFP-08.C1
The Case for Staying Fully Insured: Why the Traditional Model Is Still the Right Answer for Many Small Employers
Fully insured is the right answer for the employer below 10 lives with no internal benefits capability, no broker relationship, and no interest in developing either. The level …