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Kaiser Permanente Level Funded

A self-funded health care solution for small and midsize businesses

Level Funded gives businesses more financial protection and visibility into health care costs.1 Employees also get access to our value-based integrated care model — for healthier outcomes and more affordable care.

Level Funded is ideal for businesses with:

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    5 to 100 employees2

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    A stable and healthy workforce

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    Good financial standing

Benefits and advantages of Level Funded plans

  • Value-based care model: Our focus on prevention and coordinated, evidence-based care has made us a national leader for better outcomes and manageable costs.
  • Stable and predictable: A set monthly payment covers administrative fees, Stop Loss insurance, and maximum claims liability — regardless of utilization.3
  • Surplus credits4: If claims are lower than expected, a surplus credit can be applied toward next year’s plan costs.
  • Insight into costs: Understand your population’s total cost with monthly claims reporting, including a high-cost claims report.
 
With Kaiser Permanente, your employees get world-class, patient-centered care. Our care model delivers healthier outcomes and ensures manageable costs.
Get in touch with us to learn more

How Level Funded works

Your set monthly payment includes fixed costs (administrative services and Stop Loss insurance) and claims costs, with the opportunity for a credit if claims costs are lower than expected.

If a surplus results, then your surplus credit will be applied toward a future invoice.7,8 If a deficit results, then Stop Loss insurance covers the excess claims costs.
 

How level funded worksHow level funded worksHow level funded works

Year-end Level Funded reconciliation and settlement examples

Example
 Claims lower than expected 
 Claims higher than expected 
Total claims funded  $250,000 
 $250,000 
Actual total paid claims 
 ($200,000) 
 ($290,000) 
Surplus/deficit 
Surplus: $50,000 
Deficit: ($40,000) 
  Surplus based on the surplus share option selected (see footnotes 4 and 8) 
You don’t pay more. Stop Loss insurance covers the gap. 
Example
: 
Claims lower than expected 
Total claims funded 
$250,000 
Actual total paid claims 
($200,000) 
Surplus/deficit 
Surplus: $50,000 
 
Surplus based on the surplus share option selected (see footnotes 4 and 8) 
Example
: 
Claims higher than expected 
Total claims funded 
$250,000 
Actual total paid claims 
($290,000) 
Surplus/deficit 
Deficit: ($40,000) 
 
You don’t pay more. Stop Loss insurance covers the gap. 

Your plan options are tailored for your business

  • Choose from a variety of plans with a range of deductible and medical and pharmacy benefits.
  • Select either 50% or 67% surplus share options.7
  • Pair your medical plans with a health reimbursement arrangement (HRA), health saving account (HSA), or flexible spending account (FSA) administered through Kaiser Permanente.9

Ready to transform your employee benefits?

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Footnotes:

  •  

    1Kaiser Permanente Insurance Company (KPIC) provides administrative services and underwrites Stop Loss Insurance for the Kaiser Permanente Level Funded program.

  • 2Level Funded is not offered in all Kaiser Permanente states. You must have the required minimum number of enrolled employees to participate in the Kaiser Permanente Level Funded program. 

  • 3Monthly payment includes run-out to cover claims costs after a Level Funded Plan is terminated.

  • 4Surplus credit is only available if the Plan Sponsor renews their administrative services contract with KPIC. There is no guarantee of plan performance or return of surplus.

  • 5This is not insurance and is a voluntary program. The rewards program is open to all Kaiser Permanente Level Funded members 18 and older. However, it is not included with PPO plans. The rewards program may be discontinued at any time.

  • 6When appropriate and available.

  • 7The default surplus share option is 50%.

  • 8Actual total paid claims are net of any individual Stop Loss reimbursement.

  • 9Additional monthly administrative fees will apply with a Kaiser Permanente Health Payment Account solution.