Skip to main content

Large Group Funding Options

Blue KC offers several options for funding your health plan. It's part of our commitment to making health insurance affordable and accessible.

Large Group Funding Options

The following options are available:

Fully Insured

  • You pay a set monthly premium.
  • Blue KC accepts the risk for all costs of the health plan.

Maximum Refund

  • Allows you to receive a refund at the end of the contract year for a portion of the paid premium if your claims experience is lower than projected.
  • If claims experience is higher than projected, Blue KC absorbs the loss.

Premium Reserve Account (PCA Retro)

  • A reserve fund of 10% of the annual premium is established from any surpluses in the health plan.
  • The reserve account is held by Blue KC to offset against future costs.
  • Any surplus over the 10% reserve is paid to you
  • Should you cancel your health plan, you would receive any amount held in the reserve account.

Contingent Premium

  • Allows you to pay a reduced portion of the insured premium
  • At the end of the contract year, if the reduced premium covers net claims plus expenses, you are not liable for any additional premium.
  • If reduced premium does not cover net claims plus expenses, you are required to pay for any shortfall up to the amount of the full premium.
  • If the costs exceed the amount of the full premium, Blue KC absorbs the loss.

Cost Plus

  • Provides you with the opportunity to accept risk for the claim-related costs.
  • Prior to the beginning of each month, you would pay fixed costs. Fixed costs include administrative fees and premiums for specific and aggregate reinsurance coverage.
  • At month end, you would pay claims costs and network access fees for that month.
  • The aggregate reinsurance coverage includes a cap to protect against unexpectedly high claims expenses, while the specific reinsurance protects against shock claims on each member.

Administrative Services Only (ASO)

  • Blue KC handles the administration of your health plan, helping to eliminate paperwork.
  • Employees can check their claims, update personal information, and obtain provider information via a secure website. They can also enroll online via BluesEnroll.
  • A dedicated ASO representative will meet with you regularly, and you'll receive regular electronic reports on utilization, claims accounting, network savings, and more.