Alternative Health Plan

Alternative health plans are complete, employer-sponsored medical plans sold as a replacement for a traditional carrier plan, where the vendor assembles the provider network, benefit design, and claims administration.
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Included Health

Included Health

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Min. Group Size

-

Lives Serviced

2,500,000

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Product Description

We developed the Included Health Plan to reduce the total cost of care and prioritize predictable cost management. This high-value alternative simplifies the member experience through our All-Included Care™ model. Included Health Plan... Show More
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Angle Health

Angle Health

2.7 (2)
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0

Funding Summary

200M Series C

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About Angle Health

Angle Health is a digital-first, full-stack health insurance company that provides employer-sponsored health plans with a focus on technology, personalization, and ease of use. It operates as a carrier, Managing General Underwriter (MGU), and Third Party Administrator (TPA), using an AI-enabled platform to streamline administration for employers and offer members personalized care navigation, telemedicine, and access to a national provider network. Show More
Evry Health

Evry Health

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Healthcare Highways

Healthcare Highways

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Frequently Asked Questions

What Are Alternative Health Plans?

Alternative health plans (AHPs) are ways for employers to provide health benefits other than a traditional fully insured group policy. In a fully insured plan, the employer pays a fixed premium and the carrier takes on all the claims risk. With an alternative plan, the employer changes how coverage is funded, priced or delivered. Common examples are level-funded and self-funded plans, reference-based pricing, captives and individual coverage HRAs (ICHRAs).

Is an Alternative Health Plan the Same as an Association Health Plan?

No. Both get shortened to “AHP,” but they are different things. An association health plan lets small businesses in the same industry or region join together to buy coverage as one larger group. “Alternative health plan” is a broader term for any funding or plan design other than traditional fully insured coverage.

What Is a Level-Funded Health Plan?

In a level-funded plan, the employer pays a set amount each month. That payment covers expected claims, administration fees and stop-loss insurance, which protects the employer when claims run higher than expected. If claims come in under budget, the employer may get part of the surplus back at year-end, depending on the contract. Level funding is popular with small and midsize employers who want some of the benefits of self-funding with predictable monthly costs.

What Is Reference-Based Pricing?

Reference-based pricing (RBP) pays hospitals and providers based on a benchmark, usually a percentage of Medicare rates, instead of discounts negotiated through a carrier network. It can lower claims costs a lot. But some providers may not accept the payment and may bill the patient for the difference, so RBP plans need strong member advocacy and support for resolving balance bills.

Are Alternative Health Plans ACA-Compliant?

It depends on the plan type. Level-funded and self-funded plans, plans using reference-based pricing, and ICHRAs can all be built to meet ACA requirements. Health sharing ministries, indemnity plans and plans offering only minimum essential coverage (MEC) do not provide full ACA-compliant coverage. Larger employers using those options may still face the employer mandate penalty. Check a plan’s compliance status before choosing it.

What Are the Risks of Alternative Health Plans?

The main risk is claims volatility. In self-funded and level-funded plans, a few large claims can raise costs or trigger steep renewal increases. Stop-loss insurers may also set a higher deductible for a specific high-cost member (called “lasering”). Other risks include extra administrative work, ERISA fiduciary responsibilities, nondiscrimination testing, and, for reference-based pricing, disputes with providers.

Which Employers Are a Good Fit for an Alternative Health Plan?

Strong candidates usually have a relatively healthy workforce, steady cash flow, and enough appetite for risk to handle swings in claims from year to year. They also tend to want more visibility into their claims data. Employers facing large fully insured renewals often look at alternatives first. Very small groups and groups with known high-cost conditions may be better served by level funding or an ICHRA than by full self-funding.

How Does an Employer Switch to an Alternative Health Plan?

Most employers switch at their plan renewal. The process usually starts with gathering recent claims and census data, then working with a broker or consultant to model the options. Depending on the plan type, the employer then chooses a third-party administrator (TPA), stop-loss carrier, provider network or ICHRA platform. Leave several months before renewal for underwriting, compliance review and explaining the change to employees.

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