Self-Funded
LevelFlex™
Why pre-fund claims before they're needed? With LevelFlex™, your TPA administers the plan and requests claims funding as claims are incurred, allowing you to retain your funds longer while gaining greater cash flow, transparency, financial control, and stop-loss protection.
LevelFlex™ by Memberly
Pay-As-You-Go Self-Funded Health Plan with Cash Flow Control
LevelFlex is a self-funded health plan that allows employers to fund claims as they are incurred rather than through fixed monthly claims funding. Instead of pre-funding estimated claims, employers retain control of their funds and remit payment only as claims are processed — typically through weekly funding requests submitted by the third-party administrator (TPA).
Unlike traditional level-funded arrangements, the employer retains possession of the claims funding throughout the plan year. The TPA administers the plan by adjudicating claims, issuing Explanation of Benefits (EOBs) and Explanation of Payments (EOPs), paying providers, and submitting periodic funding requests for reimbursement. This approach allows employers to maximize cash flow while maintaining complete visibility into plan performance.
LevelFlex is generally recommended for employers with at least 50 enrolled employees, with 100 or more enrolled employees being the preferred size to maximize the advantages of claims-funded administration and cash flow management.
To protect against unexpected or catastrophic claims, LevelFlex includes both specific and aggregate stop-loss coverage. If individual or total plan claims exceed predetermined thresholds, the stop-loss carrier assumes liability for eligible claims in accordance with the policy terms. In many cases, aggregate stop-loss provides advance funding once the plan reaches its aggregate attachment point, ensuring that employers are not required to fund claims beyond their maximum financial obligation.
While weekly funding requirements naturally fluctuate with actual claims activity, the employer's overall financial exposure remains limited by the stop-loss policy. This provides the liquidity advantages of paying claims as incurred while maintaining the financial protection and risk management expected from a comprehensive self-funded health plan.
Pay-as-you-go funding
Fund claims as incurred and keep working capital longer.
Stop-loss protection
Specific & aggregate coverage caps employer exposure.
PPO or RBP
Choose national carrier networks or reference-based pricing.
Advantages
LevelFlex — Advantages
Core Advantages
- Improved cash flow control — fund claims as incurred, not through pre-funded monthly estimates
- Working capital retention — cash stays with the employer and deploys only when claims are paid
- Pay-as-you-go funding structure aligned to real claims activity, not fixed projections
- Stop-loss protection caps downside risk from catastrophic individual or aggregate claims
- Transparent, TPA-driven funding reports tied directly to actual claims experience
Financial & Cash Flow
- Smoother alignment between revenue cycles and healthcare spend
- Reduced upfront funding exposure vs. fully pre-funded self-insured models
- Ability to optimize short-term liquidity and internal cash management
- More efficient use of employer working capital throughout the plan year
- Reduced idle cash sitting in pre-funded claims accounts
Operational
- TPA-managed claims processing with structured funding requests
- Regular (typically weekly) visibility into claims activity and required funding
- Clear separation between claims administration and employer cash management
- Predictable administrative workflow tied to actual claims events
- Scalable structure for growing employee populations (typically 50+ lives)
Risk Management
- Stop-loss insurance protects against high-cost claim volatility
- Defined maximum exposure limits help stabilize financial planning
- Aggregate protection helps reduce uncertainty in total annual spend
- Protection from catastrophic claim spikes while preserving self-funded upside
- Balanced risk-sharing between employer and stop-loss carrier
Strategic
- Combines self-funded plan savings potential with enhanced liquidity control
- Greater flexibility than fully prepaid funding models
- Improved visibility into real-time claims performance
- Supports data-driven benefits strategy and plan optimization
- Enables transition pathway from fully insured to fully self-funded structures
Configuration
PPO-Based Option (Aetna, UnitedHealthcare, Blue Cross Blue Shield, Cigna)
Your LevelFlex plan can be configured as a PPO-based option, offering access to broad national provider networks through major carriers, including Aetna, UnitedHealthcare, Blue Cross Blue Shield, and Cigna. These networks provide pre-negotiated contracted rates, delivering predictable member cost-sharing, strong provider access, and streamlined claims administration.
This option is well-suited for employers prioritizing network stability, employee choice, and familiarity with established carrier platforms. It supports a traditional PPO experience while maintaining LevelFlex funding flexibility, allowing employers to balance cost control with broad access to in-network providers nationwide.
Basic Advantages
- Minimal disruption for employees
- Trusted national carrier networks
- Familiar “fully insured-like” experience with self-funded flexibility
- Broad provider access nationwide
Expanded Advantages
- Predictable in-network pricing through established carrier contracts
- Simplified member experience (ID cards, provider lookup, claims processing)
- Strong provider acceptance and reduced balance billing risk (in-network)
- Integrated care management and utilization programs through major carriers
- Digital member tools (apps, portals, telehealth access)
- Enhanced recruitment and retention value due to recognized national brands
- Easier onboarding for employees transitioning from fully insured plans
- Stable claims administration with established carrier infrastructure
Configuration
RBP-Based (Reference-Based Pricing) Option
The RBP-based configuration utilizes a reference pricing methodology tied to Medicare or other defined benchmarks in place of traditional carrier-negotiated rates. This approach enables enhanced cost control while maintaining nationwide provider access. The structure is typically supported by balance-billing protection, member advocacy services, and plan design safeguards to help ensure a positive member experience while optimizing overall plan spend.
This option is well-suited for employers seeking greater transparency in healthcare pricing, reduced fixed network constraints, and more direct control over plan costs within a self-funded framework.
Basic Advantages
- Significant potential reduction in overall plan costs
- Nationwide access to providers without traditional network limitations
- Greater transparency in how provider reimbursements are determined
- Flexibility in plan design and funding strategy under LevelFlex
- Ability to redirect savings toward richer employee benefits or lower contributions
Expanded Advantages
- Reduced reliance on carrier-negotiated PPO rate inflation
- More predictable and controllable unit pricing tied to defined benchmarks
- Built-in cost containment strategy at the claims level
- Member advocacy and negotiation support for out-of-network billing situations
- Balance-billing protection strategies to support member experience
- Strong alignment between plan utilization and employer cost outcomes
- Enhanced long-term sustainability versus traditional fully insured models
- Ability to customize reimbursement strategies by service category or geography
- Increased visibility into true underlying healthcare costs
- Greater flexibility to optimize stop-loss and overall risk management strategy
LevelFlex — FAQs
PPO & RBP — FAQs
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Plan Disclosure: LevelFlex™ is a self-funded employer health plan under which the employer funds eligible claims as they are incurred. It is not a fully insured health insurance policy. Stop-loss insurance may protect the plan against eligible claims exceeding specified thresholds but does not eliminate the employer's responsibility for funding the plan. Claims, stop-loss coverage, exclusions, attachment points, and employer obligations are governed by the applicable plan and stop-loss documents. In the event of any discrepancy, the official plan and stop-loss documents shall govern.