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Costco Executive Members can Receive Additional Savings on Level Funded Advantage Medical Plans


Eligible Executive Member employers may qualify for up to 5% savings on Level Funded Advantage plans1, which offer:


  • Predictable monthly premiums – just like fully insured medical plans
  • Potential year end savings – if claim costs are lower than was expected by plan year end, you may receive a portion of the premium back from Allied
  • More transparency – you can see actual claims activity and trends
  • Familiar plan designs – deductible based PPO or RBP plans, copays for everyday care with lower prescription copays at Costco pharmacies

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1 Offer is not guaranteed: The 5% discount is a discretionary benefit subject to eligibility requirements for small business owner Plan Sponsors who are Costco Executive Members. The 5% discount reflects the percentage reduction of the overall Plan costs from the Level Funded Advantage base rates made available to Costco Members who are not Executive Members, excluding non-commissionable fees such as network access fees. Actual discount may vary by state and is subject to applicable federal and state laws and regulations and carrier underwriting guidelines. The carrier reserves the right to modify or terminate any discount and the stop loss coverage at any time in the event of a material misrepresentation or a material change impacting the Plan Sponsor or its employee census or demographics. Eligibility for the discount is dependent on the Plan Sponsors' continued status as a Costco Executive Member. The discount is non-transferable and has no cash value.


How are benefits covered under an LFA plan?


Below is a sample plan design that shows what a member pays when they use this health insurance plan.


Freedom+ $35/$2000/80%
BENEFIT CHOOSE ANY PROVIDER - NO REQUIRED NETWORK OR PENALTIES
Calendar Year Deductible $2000 Per Individual
(Family Deductible is 2 Times the Individual Deductible))
Best Rates In-Network.
Coinsurance 80% Paid By Plan
Calendar Year Total Out of Pocket Maximum
(Copays, Deductibles and Coinsurance Count Towards Calendar Year Total Out of Pocket Maximum) 		$6000 Per Individual
(Family Limit is 2 Times the Individual Limit)
Doctor's Office Visit Copay
(See Next Page for More Info on Office Visit Benefits) 		$35 Copay
Urgent Care Copay
(Benefits Payable Some as for Doctor's Office Visit) 		$55 Copay
Non-Surgical Outpatient Expenses After Deductible Plan Pays 80%
Surgical Procedure Expenses After Deductible Plan Pays 80%
Inpatient Admissions After Deductible Plan Pays 80%
Emergency Room services After Deductible Plan Pays 80%
Preventive Services Plan Pays 100% of Covered Charges

 

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PRESCRIPTION DRUG FORMULARY PLAN

You're covered under the following RX Benefit: Formulary Plan, No Annual Max

 



NOTES:
  • Plan members can take advantage of additional Rx discounts available ONLY at Costco Pharmacy locations (See discounted costs on Rx Benefit table)
  • A Costco membership is not required for Costco Pharmacy benefits
  • $100 Rx deductible applies to tiers 2 & 3 at retail pharmacies, no Rx deductible applies at Costco Pharmacy.
  • Mail order benefit: All plans include mail order discounts – 90-day supply for 2.5x Costco Pharmacy copay amounts.
  • All Copays & Coinsurance cease once a member has reached their calendar year maximum out-of-pocket amount.
      AT COSTCO PHARMACY
TIER DESCRIPTION AT RETAIL PHARMACY
0 Over the Counter $15

$0 Copay 

(Kirkland SignatureTM)
1 Generic $15 $5 Copay
2 Brand Name $50 $25 Copay
3 Non-Formulary $75 $45 Copay
4 Costco Specialty Pharmacy Not Available 20% up to $500 after deductible

 

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3 Reasons to Consider Level Funded Advantage

  1. You may benefit when claims are lower than expected:
    You don’t buy insurance for benefits that you don’t use. Unspent claim dollars are yours at the end of the plan year.
  2. Your costs are capped and protected:
    Stop-loss insurance fully protects you from larger claims. You will never have to pay more than the maximum monthly costs.
  3. Simple, predictable budgeting:
    Level funding means there are no surprise payments – just one monthly payment.

Can we receive money back with this plan?
Possibly. With Level Funded Advantage, part of your monthly payment is allocated to a claims fund used to pay member medical expenses during the year. After the plan year ends and all eligible claims are processed, any remaining funds in the claims account may be returned to your business. Results vary by group, and refunds are not guaranteed, but this structure allows employers to potentially benefit from lower-than-expected claims.


Not every plan works for every business. If Level Funded Advantage isn’t the right match, our Strategic Benefit Advisors will review traditional fully insured options alongside level funded plans so you can make a confident, informed decision.

 

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