With Traditional Co-Pay Plans, you generally receive benefits before deductible for office visits, ER, Urgent Care, or prescriptions via small co-pays by the insured. These plans usually have lower deductibles for hospital service. diagnostic or facility charges and co-insurance or patient-sharing after deductible. Generally, these plans have a Maximum Out-of-Pocket (MAX OP) cost from $2,000-$5,000 per person per year.

Self-Funded Plans are typically utilized by groups of 50 or more employees. However, recent changes to the self-funded marketplace, driven by increased plan costs and ACA regulations, provide opportunities for smaller groups of 10 or more employees access to these plans. Although they can be a great product for healthy employee groups, they don’t make sense for just any group. PFSI can help you evaluate your specific group and help you understand the costs, risks, and benefits that may be available to you through self-funded plan options.