Next-Gen Level-Funded Health Plans
A new breed of level-funded plan — owned and operated independently of the BUCAs and designed with employers in mind.
We are focused on a new breed of level-funded health plan that we call “Next-Gen Level-Funded Health Plans.” These plans are not created by the BUCAs for the benefit of the BUCAs — they are owned and operated independently of the BUCAs. Next-Gen Level-Funded Plans are designed with employers in mind and built to incorporate modern solutions that are already working in the self-funded world. By design, they are nimbler and better able to integrate new technologies, while still featuring national networks and plan designs that are easy for members to understand.
How Next-Gen plans are different
--> Owned and operated independently — not built by the BUCAs for the benefit of the BUCAs
--> Designed with employers in mind
--> Built to incorporate modern solutions already working in the self-funded world
--> Nimbler and better able to integrate new technologies
In simple terms: Next-Gen Level-Funded Plans allow for innovation that lowers costs and improves the member experience.
Examples of innovation in Next-Gen plans
--> Leveraging independent Pharmacy Benefit Managers with transparent contracts and no hidden costs
--> Programs to help members with high-cost drugs access those drugs at little or no cost to the member and a substantial discount to the plan
--> Concierge navigator support to answer questions, guide members to the care they need, and schedule appointments to the best providers
--> Zero-cost care options for members who utilize navigation support or go to preferred providers for surgeries and imaging
These plans still feature national networks and plan designs that are easy for members to understand, while allowing for innovation that lowers costs and improves the member experience.
Next-Gen Level-Funded Plan FAQs:
Most traditional level-funded plans are built by the big carriers — we call them the BUCAs — largely for the benefit of the big carriers. Next-Gen Level-Funded Plans are owned and operated independently of them: designed with employers in mind and built to fold in the modern, cost-saving solutions already proven in the self-funded world. You still get national networks and easy-to-understand plan designs; you just also get innovation that actually lowers costs and improves the member experience.
A pharmacy benefit manager, or PBM, is the company that administers your prescription drug benefit. The trouble is that many traditional PBMs make their money through hidden fees, spread pricing, and rebates they don't fully pass along — costs that quietly land on you and your employees. A transparent PBM uses straightforward, flat-fee pricing, passes rebates through, and gives you full visibility into your drug spend. Next-Gen plans lean on this kind of transparency because pharmacy is one of the fastest-growing pieces of any health plan.
Healthcare is confusing, and most people don't know where to find the right care at the right price. A concierge navigator gives your employees a real person to call — someone who answers questions, helps them understand their benefits, points them to high-quality providers, and even helps schedule appointments. Better guidance leads to better care decisions, which improves your employees' experience and helps hold down costs for the plan at the same time. It's a win on both sides.
Yes, and this is one of the areas where Next-Gen plans shine. These plans can layer in programs that help members access high-cost medications at little or no cost to them, while securing a substantial discount for the plan. It's a good example of the kind of modern solution that traditional carrier-built plans are often too rigid to offer. If specialty drug costs are a concern for your group, let's talk through the options.