Discover the Advantages of Level-Funded Health Plans

BusinessEDGE® plans are level–funded plans designed to meet your health benefit coverage and budget needs.

A level–funded health plan, also known as a partially self–funded health plan, is a health insurance plan that combines the cost savings of a self–funded plan with the predictability of a fully insured plan.

Our plans are designed to reduce health benefit costs so that you can invest the savings back into your organization. Fixed premiums make it easier to manage benefit costs. With a fixed premium, you pay the same amount each month — no need to worry about adjusting your budget.

Optima Health offers an integrated solution, which makes transactions faster, more efficient, and more secure, and avoids the hassle of coordinating with multiple companies. With our plans, you also get value-added programs and benefits. Our programs are easy to use and can help improve the health of your employees.

BusinessEDGE — A Cost–Efficient Health Benefits Funding Alternative

BusinessEDGE plans have a fixed monthly payment while offering you protection from high claims. This option is available to groups with 5–150 enrolled employees effective December 1, 2021.

This 12–month plan offers stop–loss protection against catastrophic claims and 12 months of fixed premium payments based on predicted claims history.

Starting January 1, 2022, after the 12–month run–out period, if the group is still insured with Optima Health and actual claims history is lower than predicted, the group can collect a refund. The refund percentage of the unused claims fund is determined at the time the group is initially set up.

Value–Added Benefits

With BusinessEDGE, you also get value-added programs and benefits, such as:

  • award-winning nutrition, fitness, smoking cessation, and screening programs1
  • member discounts on products and services
  • movement and fitness programs
  • tools to help manage prescription benefits
  • a coaching program for expectant mothers
  • out-of-area (OOA) dependent program2
  • variety of digital tools and services, including a mobile app
  • and more!

Still Have Questions?

Get answers to frequently asked questions.

Check out the new Underwriting and Enrollment Checklist

We Want to Hear From You

Please contact us for more information.

Request a Quote

Call Us — 1-844-250-7050, Monday – Friday, 8 a.m. – 5 p.m. EST

Optima Health sunsetted the BusinessEDGE eliteTM plans, as of June 1, 2021. Any group currently enrolled in a BusinessEDGE elite plan will remain until the end of their contract date.

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The member will be required to submit documentation to enroll.