Difference Health Plan

A Self-Funded Health Insurance Solution for Mid-Sized Businesses 

Moving from a fully insured health plan to a self-funded one can be daunting. It’s intimidating to take on the risk of full claim exposure.  

With The Difference Health Plan, you get complete confidence that we will guide you or your client to the right self-funded plan design.  

The same level of dedication and knowledge that you have come to expect from The Difference Card will be present in every decision you make with The Difference Health Plan.  

The Difference Health Plan Advantage 

Innovation, customization, and specialization is in the very DNA of The Difference Health Plan.  

We use a proprietary platform with deep expertise in building custom solutions. Just like The Difference Card, The Difference Health Plan can accommodate complex plan designs and account structures.  

The Difference Health Plan has a robust vendor connectivity system. We can connect to more than 150 vendors including Carrier Networks, RPB Vendors, Pharmacy Benefit Managers, and Concierge Services.

Why should you consider going self-funded?

Savings are built into the plan design: 

  • The premium tax you pay is lower than other health insurance options 
  • The prescription rebates go to the employer NOT the health insurance carrier 
  • Administrative fees on average run about 12% less than fully insured health plans 
  • The savings achieved by The Difference Health Plan are used to fund the claims costs 

Plan administration is streamlined: 

The Difference Health Plan takes care of everything. The plan functionality that is typically handled by the Insurance Carrier is taken over by The Difference Health Plan which allows for more control and greater service levels.  

Large claim protection & max liability coverage: 

  • The Difference Health Plan is protected by reinsurance. If a claim exceeds the agreed upon amount, the employer is not responsible for any amount of the claim limit.  
  • Aggregate stop loss insurance protects the employer against total claims incurred by the entire organization. 

What is built into The Difference Health Plan?

The components of The Difference Health Plan are similar to most self-funded solutions but have been hand-picked by us to ensure the highest level of quality and success.

With The Difference Health Plan, you will get: 
  • Cost Containment Solutions 
  • Transparent Pharmacy  
  • Integrated Consumer Account Options 
  • Peace of Mind with Stop Loss Protection 
  • Online Enrollment & Compliance Management  
  • Unparalleled Customer Service 

Download A One Page Flyer

Ready to learn more about The Difference Health Plan Self-Funded Solution?

Contact your Difference Card Sales Representative or request a proposal today for more information.

The Building Blocks of The Difference Health Plan

Cost Containment Solutions

Cost containment is at the heart of The Difference Health Plan. 

National Network Partnerships 

We work with National PPO Networks to provide the very best options to you or your clients. Our National PPO Networks focus on cost, quality and improving the member experience with their health insurance provider.  

For our In-Network Providers, you: 
  • Get the contracted provider rates 
  • Can receive 50% or more in provider and facility discounts 
  • Will never be balance billed 
For our Out-of-Network Provided, you get: 
  • Medical bill negotiation  
  • Precision claim reviews  
  • Established reimbursement levels 

Care Navigation  

Our care navigation tool delivers a new standard of care through clinical expertise that is uniquely informed by member data.  

Included in our Care Navigation Tool: 
  • An intuitive app that serves as the central hub for all healthcare and benefits information for members. 
  • Personalized and dedicated care teams for each member including a clinical lead, health guide, billing specialist, mental health specialist, and a pharmacy specialist.  
  • Tools to engage and educate members with onboarding of new members, proactive outreach 
The impact of our Care Navigation Tool: 
  • 15% lower healthcare spend by members 
  • 41% member engagement rate 
  • An 84 Net Promoter Score for this tool

Transparent Pharmacy Options

Our Difference Health Plan Pharmacy Coalition brings deep discounts, managed specialty medications and a 100% rebate share. After extensive research with over 20 PBMs, we selected three preferred top tier PBMs to deliver transparency and the best price for our clients.  

The Difference Health Plan Pharmacy Coalition provides: 

  • More transparency 
  • Lower pharmacy costs: 
  • Increased flexibility 
  • Detailed reporting 
  • Stronger contracts 

With The Difference Health Plan Pharmacy Coalition, we have created a Prescription Drug Benefit Program that offers superior clinical and financial offerings, which creates significant cost savings for clients.  

Embedded cost containment features include: 

  • Clinical protocols and programs 
  • Real-time review of high-cost and specialty medications prior to payment 
  • Patient and Manufacturer Assistance Program for select Specialty medications  
  • A 340b Pharmacy Program for 20/30% savings 
  • A Telehealth Specialty pricing program  
  • Management of non-specialty medications through state-of-the-art member engagement therapeutic substitution program 

Sixty-four percent of covered workers are in a self-funded health insurance plan.

Of this 64%, only 21% are small to mid-sized business with less than 200 employees. The Difference Health Plan aims to bring a solution to make self-funding more widely available for smaller organizations.

Integrated Consumer Account Options

The Difference Health plan can work together with our Difference Card. With The Difference Card, you can load multiple Consumer Accounts onto the card – making it easy for members to access their funds.  

The Difference Card can serve as a one-card solution for: Load multiple solutions onto one Difference Card

Peace of Mind with Stop Loss Protection

The Difference Health plan gives you access to top rated carriers to manage the risk associated with a self-funded arrangement.  

Our carrier partners can protect you from large claims and put an overall maximum on your healthcare claim liability.  

The Difference Health Plan offers both level funded and traditional corridor self-funded stop loss arrangements.

Stop Loss Carrier A.M. Best Financial Rating Stop Loss Carrier A.M. Best Financial Rating
American Fidelity A+ QBE Insurance A
Anthem A++ Sun Life Financial A++
Berkley A&H A++ Swiss Re A+
Berkshire Hathaway  A++ TMHCC A++
HMIG A Unum A
Optum Health A Voya Financial A

Online Enrollment & Compliance Management  

With The Difference Health Plan, you get access to our Differences Benefits Admin System! 

Streamline your benefit administration with the Difference Benefits Admin System

The Difference Benefits Admin System is a comprehensive suite of products including a new online enrollment services platform, HR Portal, COBRA Administration, and our interactive benefit decision tool: DANNY!

With the new Difference Benefits Admin System, you will have access to our Online Enrollment Services Platform.

We can provide you with automated or self-service COBRA administration. In addition, the system can help you to better manage your employee benefit offerings such as Health Savings Accounts, Flexible Spending Accounts, Health Reimbursement Arrangements, Vision Insurance, Dental Benefits, Commuter Accounts, Life and Disability Insurance.

Learn more about The Difference Benefits Admin system HERE. 

Unparalleled Customer Service

Our Member Services Team is filled with knowledgeable representatives who can assist members with any questions they may have and will help them gain a better understanding of how their benefits work. Our goal is a best-in-class experience for our clients. 

Our Member Service Team is ready to help: 

  • We support your employees from 8 AM to 9 PM ET with helpful and compassion associates. 
  • We offer 24/7, 365 days a year automated phone support. 
  • We are available to help employees through phone support, email and live chat. 
  • We keep wait times low. Our Average Speed of Answer when calling Member Services is less than 45 seconds. 
  • Check out what our clients are saying.

PRODUCERS & BROKERS

Ready to learn more about how to take your clients self-funded?

Request a proposal to learn more about The Difference Health Plan.

EMPLOYERS & PLAN SPONSORS

Interesting in exploring a self-funded health insurance option?

Request a proposal to learn if The Difference Health Plan is a good fit for your company.

    Resource Download

    Please fill the fields below to download resources.