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Best of Both Worlds

An alternative way to fund health care

In today’s changing work environment, there’s no single health plan that addresses the specific needs of every employer. And it’s more important than ever for businesses to offer comprehensive benefits to support employee health while effectively managing their year-over-year cost of coverage. That’s why Kaiser Permanente of the Mid-Atlantic States and Universal Fidelity Life Insurance Company (UFLIC), through its subsidiary Universal Fidelity Administrators Company (UFAC), have collaborated to structure a unique program that offers employers the opportunity to do both.

Best of Both Worlds offers both regional HMO and nationwide PPO plan coverage for a competitive benefit package that ensures affordability and choice. Flexible funding mechanisms allow for the diversification of group risk for better financial outcomes. Traditionally, employers choose between funding types and offer either fully insured, level, or self-funded health plans. Best of Both Worlds makes it easier for employers to:

  • Control the risk of high increases by diversifying membership between insurers and funding types.
  • Actively participate in managing the increasing costs of care.
  • Offer a choice of carriers and benefit plans so employees can choose how they want to access care.

Kaiser Permanente’s Best of Both Worlds package addresses the issues that many businesses face with practical solutions that benefit their employees—and their bottom line.

Business challenge

Best of BOTH WORLDS solution

Managing risk

As with any investment, diversification of risk protects the whole. Utilizing risk control techniques and dividing membership between carriers helps to mitigate the chance of high cost increases for either plan. Our strategy is to work in collaboration with our customers and partners to implement a product that offers year-over-year cost savings.

Controlling costs

UFLIC, through its subsidiary UFAC, offers a surplus settlement for when plan performance is better than projected—100% of the employer’s unused claims fund (after all claims and fees) is returned to the employer. In years where claims are higher than expected, one of the most affordable HMO plans in the Mid-Atlantic States can help lower total plan costs.

Delivering access and choice

A regional, prepaid integrated HMO network combined with a nationwide level-funded PPO offers a one-stop shop, allowing employees to choose how they access care. Plus:
  • Employer situs can be anywhere in the United States.
  • There are no restrictions on plan membership or enrollment for either HMO or PPO plans, or on the percentage of the membership located in the Mid-Atlantic region.
  • Highly competitive HMO and PPO rates, with a surplus settlement opportunity for 100% return of the employer’s unused claims fund.

Here’s how combined care can reduce costs

The advantages of integrated care delivery through a regional HMO:

  • Connected care closes care gaps to keep costs down
  • A focus on prevention helps keep employees healthy to avoid high costs
  • $0 or low-cost virtual options offer convenient, affordable care
  • Quality and affordability from Kaiser Permanente, named the nation’s best at delivering high-quality care at a sustainable cost1

The advantages of a nationwide PPO for employees located throughout the US:

  • Case management for high cost conditions keep costs down
  • Aviator Advantage direct contract case management offers cost savings for both employer and employees
  • Pharmacy benefit management includes aggressive MAC pricing for generic drugs to enhance discounts through negotiated reimbursement improvement, with a shift in utilization mix to more favorably priced pharmacies
  • Transparency for plan performance, with access for both the broker and employer
  • Return of 100% of the employer’s unused claims fund

NOTICE: Best of Both Worlds is a brand name used for health benefit plans that include services provided by Universal Fidelity Life Insurance Company, through its subsidiary Universal Fidelity Administrators Company and its vendors, and marketed by Kaiser Permanente of the Mid-Atlantic States. This material is for information only and is not an offer or invitation to contract for coverage. It contains only a partial, general description of plans and services and does not constitute a contract of coverage. Eligibility is subject to underwriting guidelines. Plan features, including rates, and availability may vary by location and are subject to change. All health benefit plans contain exclusions and limitations. See the current applicable plan documents for details and a complete description of benefits, exclusions, limitations, and conditions of coverage.