Level-Funded
LevelMax™
With LevelMax™, enjoy the savings of self-funding with predictable monthly payments. Your plan costs and expected claims are combined into one level payment, with stop-loss protection and the opportunity to receive unused claims funds for additional savings.
LevelMax™ by Memberly
Level-Funded Health Plan with Fixed Monthly Payments and Stop-Loss Protection
LevelMax combines the financial advantages of a self-funded health plan with the simplicity and budget certainty of fixed monthly funding. Employers make a consistent monthly payment that covers expected claims, administrative services, and stop-loss protection, with no additional funding obligations beyond the agreed-upon maximum.
The plan is funded through fixed monthly contributions that are actuarially calculated to cover the plan's maximum annual liability, providing predictable budgeting and eliminating the risk of unexpected funding requests. Throughout the plan year, the third-party administrator (TPA) administers claims, monitors the claims account, and provides regular reporting, giving employers complete visibility into plan performance.
At the conclusion of the plan year and applicable claims run-out period, the claims account is reconciled. If claims are lower than anticipated, any eligible unused funds remaining in the claims account may be returned to the employer in accordance with the plan terms and stop-loss arrangement. Depending on the group's size, underwriting, and claims experience, employers may receive a refund of 50% to 100% of the remaining claims account balance.
LevelMax delivers the cost-saving potential and transparency of self-funding while providing the financial stability and predictable monthly budgeting traditionally associated with fully insured health plans.
Fixed monthly cost
Predictable, budget-friendly funding capped at max liability.
Stop-loss protection
Specific & aggregate coverage caps employer exposure.
PPO or RBP
Choose national carrier networks or reference-based pricing.
Advantages
LevelMax — Advantages
Core Advantages
- Predictable monthly healthcare costs — fixed premium-like payment covers claims funding, stop-loss, and admin
- Protection from unexpected claims volatility with individual and aggregate stop-loss coverage
- Potential savings vs. fully insured plans by eliminating traditional carrier margins
- Opportunity for claims surplus savings — surplus return or renewal credit when claims perform well
- Transparent healthcare spending with visibility into claims performance and utilization trends
Financial & Budget
- Fixed monthly funding obligation for easier budgeting and forecasting
- Improved cost predictability without large mid-year fluctuations
- Reduced financial uncertainty — stop-loss limits catastrophic exposure
- Better alignment between cost and actual employee healthcare utilization
- Potential renewal stability when claims performance is favorable
Operational
- Simplified employer administration — TPA manages claims, eligibility, and reporting
- Integrated claims management with utilization insights and reporting
- Professional third-party administration for compliance and operations
- Streamlined transition pathway from fully insured plans
- Designed for small and mid-sized employers seeking self-funded advantages
Risk Management
- Stop-loss protection included for high-cost individual and aggregate claims
- Defined financial exposure — employers know their maximum monthly commitment
- Reduced risk vs. traditional self-funded plans — no unlimited claims liability
- Balanced risk-sharing between employer upside and stop-loss protection
- Greater control over plan risk through claims trend insight
Strategic
- Combines self-funded savings potential with fixed monthly budget certainty
- More control over healthcare spending with transparent claims performance
- Data-driven benefit decisions informed by utilization and cost drivers
- Competitive employee benefits solution while managing rising healthcare costs
- Pathway to greater flexibility and more advanced self-funded strategies over time
Configuration
PPO-Based Option (Aetna, UnitedHealthcare, Blue Cross Blue Shield, Cigna)
Your LevelMax 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.
LevelMax is well-suited for employers prioritizing network stability, employee choice, and familiarity with established carrier platforms. It supports a traditional PPO experience while maintaining LevelMax funding predictability, 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 LevelMax 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 LevelMax
- 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
LevelMax — FAQs
PPO & RBP — FAQs
Ready to see what LevelMax could look like for your group?
Get a tailored quote with PPO and RBP scenarios side by side.
Apply Now
Request your LevelMAX proposal
Share a few details and your employee census — we'll build a customized proposal for your group.
Step 1 of 4 — Your info
Step 1 of 4
Your information
Tell us how to reach you.
Plan Disclosure: LevelMax™ is a level-funded employer health plan and is not a fully insured health insurance policy. The employer funds predetermined plan costs, including claims funding, with stop-loss coverage intended to limit eligible claims exposure subject to the terms and limitations of the applicable stop-loss policy. Any potential return of unused claims funds is subject to the plan's specific funding arrangement and contractual terms and is not guaranteed. In the event of any discrepancy, the official plan and stop-loss documents shall govern.