Find the Funding Solution for Your College or University

An EmblemHealth representative can help you explore the various funding methods we offer to find one that meets your bottom-line objectives.

The most common conventional and alternative options include:

Experience-Rated

Historical claims experience is used as the basis for projecting future claims and determining the premium. These arrangements include pooling of individual high-cost claims to protect against the effects of catastrophic claims.

Availability: Institutions with 51 or more eligible enrollees.

Prospective-Rated
These arrangements enable self-insured institutions to take advantage of the quality care and competitive provider reimbursement rates available through EmblemHealth’s National Network. This program offers claims processing and customer service for a low per-enrollee administrative fee. Anticipated claims experience is evaluated for a future policy period based on an institution’s actual experience and the performance of the EmblemHealth pool for similar businesses. The cost of the plan is determined and fixed in advance of the policy period, and the institution is not eligible for any retroactive rate refunds. Losses (deficits) are not carried forward.

Availability: Institutions with 51 or more eligible enrollees.

Retrospective-Rated
This approach evaluates and measures past claims data to estimate future costs of providing benefits based on actual experience. The institution is eligible for retroactive rate refunds when the earned premium exceeds the plan's overall expenses.

Availability: Institutions with 1,000 or more eligible enrollees; these arrangements are subject to underwriting review and approval.

Deferred Premium

Eligible institutions are allowed to remit a percentage of their gross earned premium on a monthly basis, called the "payment rate." The difference between the payment rate and the gross earned premium rate is "callable" by EmblemHealth at a later date, depending upon claims experience and other factors.

Availability: Subject to underwriting review and approval.

Community-Rated

This methodology combines overall medical cost per plan to determine a standard premium rate for that plan.

Availability: All institutions with fewer than 51 eligible enrollees and all faculty and staff enrolled in EmblemHealth HMO plans.

Administrative Services Only (ASO)

Administrative Services Only (ASO) enhances cash flow by allowing the institution to reimburse EmblemHealth solely on the basis of paid claims plus administrative fees. This rating arrangement is not insured and the institution is responsible for all claim payments and administrative charges associated with the plan. Stop-loss insurance is recommended for all ASO accounts, but is required for those with less than 1,000 eligible enrollees. You retain the flexibility of securing your own stop-loss quote through a vendor of your choosing or having EmblemHealth request a quote through one of its preferred vendors.

Availability: Institutions with 250 or more eligible enrollees.

EmblemHealth offers conventional and alternative funding arrangements and will consider special funding arrangements as requested by prospective institutions — including ASO self-insurers — contingent upon the size of the group.