1. Affordable & Compliant
ACA Group Plans
Providing affordable options to your
employees in the current
marketplace can be overwhelming,
especially related to ACA
Compliance. Not anymore. Our
exclusive programs and proven
strategies will make your Benefit
Administration and HR
recordkeeping much easier to
manage!
Self-Funded Plan Administrators, LLC

2. The ACA Challenge to Controlling Health Care Premiums
For many applicable large employers, the Affordable Care Act (ACA) Play or
Pay rules are forcing them to seek better solutions to manage the THREE
‘C’s of health plans:
Cost, Compliance and Communication
Self-Funded Plan Administrators is the Three C’s Solution for many
employers, especially service industries and variable-hour employers like Home Health Care,
Staffing Companies, Franchisee’s and Seasonal employers.
We provide self-funded options for small and large employers that meet the Individual
Mandate and both Employer Mandates of Affordability and Essential Health Benefits (EHB),
thus avoiding all potential penalties. Plus our ACA Compliance Team helps establish your
affordability calculation, manages your reporting and required notifications, can integrate with
your payroll vendor and monitor your on-going eligibility in an automated, auditable and secure
process.
Our on-going Communication Team includes online, mobile and call center enrollment in
several languages and we offer a state of the art HR platform through Workforce. Our system
manages Open Enrollment, eligibility updates throughout the year, plan information, benefit
summaries, network information and self-service for eligibility and address changes by your
employees.
Our HR Platform solution will save your HR department hours of
service related issues every month!
Our Plans are designed to meet all of your associates healthcare needs and budgets. Our most
popular program allows your employees the choice between these 3 Health Plan Options:
(1) Wellness Only Options - $40 to $60 month maximum cost
(2) A Limited Medical Option - Includes Wellness, Office Visits, Teladoc, Prescription
Copays and Limited Medical reimbursements - $80 to $200 month maximum cost
(3) A HSA or PPO Option – Fully ACA compliant options with premium savings over
15 to 25% or more from traditional fully-insured options

3. The Cost of Employee Benefits
Escalating health care costs in recent years have made it increasingly difficult for employers to
provide health insurance benefits to their employees at reasonable cost. With the additional
burdens being placed on employers under the ACA (Patient Protection and Affordable Care
Act), employers must seek alternative ways and means to keep their benefit programs under
control.
Some have opted to drastically reduce benefits; others have chosen to change insurance
carriers frequently, utilizing whichever company that happens to have competitive rates at that
time. Both of these options can have a negative impact on employees, and is certainly only a
short term solution to cost control.
For most fully insured employers they never really know their true cost of insurance either. It is
frustrating that employers rarely ever or never get to see what their actual claims experience is
during a given year, especially when they know they have low claims utilization. In many cases
this employer is heavily subsidizing an insurance risk pool whose loss ratio is much higher than
his own. Why have more employers not considered self-funding?
This is due to a lack of knowledge about how self-funding works among employers and brokers
alike. Additionally, insurance carriers have been slow to develop true self-funded products for
the under 100 employee market segment that are manageable.
That is until now.
We believe that a proper self-funded plan is 100% transparent on claims, is flexible in benefit
design, provides employee choices and is easy to administer. That is exactly what we do, with a
focus on: Cost, Compliance and Communication
Want more information? Visit us online at www.self-funded.us or contact us at 844-222-3190
and speak with an account representative today
Advantages of Working with Self-Funded Benefit Administrators Automated Platform
 Includes a state of the art Open Enrollment and ongoing Benefit Management platform
 Automated on-boarding with direct carrier and payroll feeds – no more paper!
 Great employee engagement platform and enrollment tool - interactive benefit guidance
 Attractive, comprehensive, compliant and affordable benefit packages online
 Complete, guaranteed ACA compliance for the company and employees
 Call center support with both certified benefit and HR specialists
 Complete automated employee files with self-service portal

4. Feasibility of Self-funding
When a fully insured carrier charges high premiums they establish a reserve fund, benefit from
the use of your reserve funds and profit further from the low claims utilization of your group. As
an alternative, why not share in the financing of your plan to the extent that it is feasible from
an experience standpoint?
Self-funding means sharing the surplus, but it also means sharing the risk. You, as the buyer,
however, have the privilege of sharing only in the risk that your own circumstances dictate.
Risks can be categorized as:
The Cost Efficiency of Self-funding
The most efficient purchase of insurance is to insure for unpredictable losses, not predictable
losses. No matter how high the cost of medical care, statistics indicate that adverse claims
experience normally result in extensive claims by a limited number of individuals.
Consequently, it is wise to purchase insurance to protect again this risk. The amount of
insurance necessary is dependent upon the size of the group. Under the new carrier portfolios,
it is feasible to have a self-funded plan with as few as 10 employees.
By purchasing insurance only for unpredictable or catastrophic claims, you greatly reduce high
premium costs and thereby create cash savings to fund predictable claims. A breakdown of
health insurance premiums under self-funding looks like this:

5. The Claims Pre-Funding is the surplus fund. Companies that have relatively low utilization will
retain the unused funds – just like the fully insured carriers have been doing for years.
The Stop-loss coverage comes in two forms: Specific and Aggregate.
SPECIFIC STOP-LOSS PROTECTION - This provides a maximum dollar amount of all
covered claims that a benefit plan would pay on any one individual during a plan year.
The stop-loss carrier reimburses the plan for claims paid in excess of the specific stop-
loss.
AGGREGATE STOP-LOSS PROTECTION - This is protection coverage to limit the total
liability on all participants on a small plan year basis, thereby allowing the plan to
budget for a maximum annual liability.
THIRD PARTY ADMINISTRATOR - A third Party Administrator is a licensed administrator
providing all of the administrative services previously rendered by your insurance
carrier.
The Advantages of Self-funding
• REDUCED FIXED COSTS - A Third Party Administrator will administer your plan with less
overhead expense than an insurance carrier.
• LOW CLAIMS UTILIZATION - Most group insurance plans have no provision for refunding
overpayment of premium, effective coordination or subrogation of benefits.
• REDUCED PREMIUM TAXES UNDER THE ACA – Self-funded plans enjoy substantially
lower taxes than fully insured plans under the ACA (2% versus 10 to 12%)
• INTEREST OR RESERVES - Your company retains the claim reserves traditionally held by
insurance companies.
 Under self-funding, employers put money into a trust fund (regulated by
ERISA) to pay employees' medical claims. This option comes instead of paying
an insurance company a fixed, negotiated fee to pay the claims. The trust
fund keeps any profits on behalf of workers to offset future expenses.
 To make sure they don't end up paying too much for catastrophic losses, such
as if several workers required extremely costly heart transplants, self-insured
firms also buy re-insurance, allowing them to set in advance the maximum
losses they face (Aggregate Stop-Loss).

6. Self-Funded Plan Administrators, LLC (SFPA) is a Third Party Administrator
dedicated to the administration of employee benefit programs and specializing in self-funded benefit
plans. We have offices in Columbus, Omaha and Las Vegas and service accounts from coast to coast.
Our mission is to provide timely and cost effective services to our clients in order to achieve their benefit
objectives. We maintain state-of-the-art hardware and systems to enable us to provide timely and
responsive administrative services to our clients. Our claims system is QicLink, one of the premier
systems developed by Trizetto, a Cognizant company.
We believe an employer’s health benefit plan should be established on a partnership basis with the
administrator meeting the specific needs of each client and its employees. SFPA’s experienced
management and service team has been administering benefits for hundreds of clients since 1984.
Our TPA Services Include:
• Claim adjudication, including AutoAudit to detect fraudulent claim activity;
• In-house re-pricing of non-network claims;
• Direct negotiation of large hospital claims;
• Prescription management and rebate sharing;
• Programming eligibility, evaluation and programming of benefit plans;
• Provision of all enrollment, COB and claim forms;
• Loading of claim history;
• Management reporting;
• Medical necessity determination;
• Subrogation pursuit;
• Coordination of benefits;
• Implement on-going plan design changes;
• Changes in eligibility;
• Toll-free number for claim inquiries;
• Identify unbundling, upcoding and other provider billings;
• Administer COBRA and HIPAA; billing functions can be provided at an additional cost;
• Coordinate catastrophic claims;
• Assign dedicated service team;
• Assign dedicated claim processing team;
• Coordinate utilization review;
• Provide financial and claim utilization reports;
• 5500 information;
• Stop loss filings.
• Complete Section 125 and IRS tax-saving plan administration, wrap documents, HRA, FSA,
Child and Dependent Care and Parking program claim administration

7. Plus SFPA Services Include:
• Complete automated HR system through Workforce (a bswift provider)
• Full ACA compliance, reporting, auditing and updates
• Fully insured offerings including: health, dental, vision, life, disability, 401k
• Voluntary worksite benefits and enrollment services with bi-lingual call center support
• Simplifi HR Solutions exclusive DOL Audit Shield – HR audit to avoid audits
• Fee-for-service, unbiased, independent benefit consulting
• Property Casualty and Liability insurance
• Ohio based Workers Comp PEO program
• National self-funded and fully-insured workers comp programs
Self-funded Plan Administrators Broker Opportunities
Our broker partners benefit in many ways that is unique to the industry - protecting your labor.
Our employer agreements guarantee our administration costs for two years and we will not
honor Agent of Record changes during this timeframe.
We have a professional, experienced team dedicated to providing the best in class products and
services and we are not a quote mill. Our benefit partners will benefit greatly from our
programs, but should have an understanding of self-funded principals and must demonstrate a
competent level of closing and retaining business. We are your resource for sales, not
spreadsheets.
Quoting Requirements:
Proposal requirements are based on the eligible population and participation percentage of a
company. Segments include:
10 to 99 Market Segment:
1. Current benefit summary and desired benefit plan
2. Employee health statements (applications, FormFire, etc.)
3. Copy of most recent renewal and billing statements
4. Electronic census of all eligible employees. Please include: Name, Sex, date of Birth,
Date of Hire, and Dependents if covered
100+ Market Segment:
1. Current benefit summary and desired benefit plan
2. Claims experience, including large claims, shock claims, most recent summary reports
3. Copy of last two years of rates, most renewal and current billing statements
4. Electronic census of all eligible employees. Please include: Name, Sex, date of Birth,
Date of Hire, and Dependents if covered