Spaggregate^SM is an innovative “maximum-funding” mechanism for self-funded benefit plans developed by Entrust.  This unique financing approach provides all the advantages of an ERISA plan with the payment simplicity of a “fully insured” health benefit program.

Spaggregate^SM offers:

• Elimination of Most Premium Tax:
  There is no premium tax for the self-insured claim fund. Premium tax is applied only to the stop-loss premium, which is significantly less than a fully insured plan.
• Lower Cost of Operation:
  Employers frequently find that administrative costs for a self-insured program administered through a TPA are lower than those charged by an insurance company.
• Carrier Profit Margin and Risk Charge Eliminated:
  The profit margin and risk charge of an insurance company are eliminated for the claim funding portion of the plan.
• Effective Claim Management:
  Entrust provides fast, efficient claims service as well as innovative and comprehensive cost management of claim expenses.
• Control of Plan Design:
  The employer has complete flexibility in determining the appropriate plan design to meet the needs of their company and the plan participants. If Entrust reporting tools indicate the existence of plan abuse or areas of excessive utilization, we will assist the employer in redesigning the plan.
• State Mandated Benefits are Avoided:
  State regulations mandating costly benefits are avoided because self-funding is regulated by federal law (ERISA).
• Administration Tailored to the Employer’s Needs:
  Entrust provides the employer with flexible services to meet the employer’s needs in benefit design, billing, compliance, communications and claim adjudication.
• Risk Management Effectiveness Through Stop-Loss Insurance:
  The employer may choose the amount of risk retained and the amount to be covered by stop-loss coverage.

Claim Funding and Payment

The maximum plan cost and simple monthly payment approach of Spaggregate^SM is guaranteed by the participation of an insurance carrier providing stop-loss coverage.

• During the course of the plan year, the employer’s monthly payments are used to fund a claim reserve and to pay premium to the stop-loss carrier. 
• As claims are presented for payment, they are paid first from the claim reserve. 
• If the reserve is inadequate to pay bills presented, the stop-loss carrier makes the payment. 
• This claim payment procedure is seamless and requires no participation by the employer.

At the end of the plan year, if the claim reserve is not depleted by paid claims, any remaining funds are retained by the plan's trust.  They can be applied to the cost of the next year’s Spaggregate^SM Health Benefit Plan or used to pay for or fund medical insurance programs or expenses for plan participants.