Member FAQ
Members can view Frequently Asked Questions by logging in to our Member Benefit Portal!
What is self-funding?
A self-funded, or self-insured plan, is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, self-insured employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a fully-insured plan.
What is KPPFree™?
We have invented a way to allow self-funded employers to connect with low cost, high quality, free-market-minded providers, no matter who provides primary TPA services for the health plan.
The KPPFree™ (Kempton Premier Providers®) program includes providers who believe in free market transparency and that cost plus quality create value. They offer our self-funded employer clients their best price because they want to work directly with employers in their community.
KPPFree™ is a voluntary benefit that incentivizes participants to make non-emergency healthcare decisions based on cost and quality.
- Learn more about KPPFree™.
What plan designs can you support/administer?
Through an innovative plan design, we can create a benefit structure suited to meet your unique needs.
We offer administration for:
- Traditional self-funded benefit plans
- Plan administration and benefit designs based upon free market principles
- Reference Based Pricing (RBP) benefit structures
- Level-Funded plans
We can administer any combination of these options, or offer you completely out-of-the-box solutions.
Do you take commissions?
TPAs generally have multiple revenue streams, all designed to hide from you their exact compensation. Commissions on policies, products, and other vendor services, a percentage of subrogation recovery, a percentage of negotiated savings – there are many ways a TPA can increase their revenue stream and consider it “standard industry practice.”
We do not receive, or retain, a percentage of commission on your stop-loss policy, or any portion of subrogation recovery, PBM rebates, or negotiated savings. PPO and other vendor fees are a direct pass-through cost to the client and are not included in the administrative fee.
What are your administrative fees?
We do not feel that the standard practice is in the best interest of our clients.
Because of the difference in our core values, all of our services are included under one flat per-employee-per-month administrative feed. Services outside of our standard administration are offered at a fixed, flat fee and quoted to you up-front.
What size group is a good fit for self-funding?
Smaller than you might think!
We have markets to fit almost any size group – from traditional self-funded benefit options to level-funded products.
What provider networks do you work with?
Please visit the Network Provider Directory section for the most up-to-date list of the PPO networks available.
Contact us if you do not see the network you are interested in.
What companies do you work with for reinsurance?
We have great relationships with many stop-loss carriers and MGUs.
Contact us to discuss your stop-loss needs.
What is a list of things you need in order to provide a quote?
The information we need may differ based upon the services you are interested in.
- Full administration with stop-loss
- KPPFree™ Bolt-on options
- Administrative Services Only (ASO)
Please contact us to us for a current list of information we need to provide a quote.