Balanced Funding

Not your traditional insurance plan

Unlike traditional fully insured plans, Balanced Funding combines fixed monthly payments with Administrative Services Only (ASO) benefits from Highmark — and adds stop-loss insurance* to protect your cashflow.

Fixed Monthly Payment          +

You pay the same amount, every month.*

Administrative Services Only (ASO) +

Nobody likes paperwork. We’ll process all your claims for you. The cost of these claims is factored into your monthly bill.

Stop-loss Insurance* *

If the unpredictable happens, you’re protected from extremely large or numerous claims.

How it works

First, you’ll open a specially designated bank account. You will deposit the same amount of money into this account every month. How much? Here’s the formula:

Maximum Claims Liability    +

That’s the most we think your claims will cost per month.

Administration Fees       +

What you pay for having us process your claims.

Stop Loss* Premium

Protection against large or numerous claims.


The number of employees you have.

=   The amount you deposit in your account per month.

Then, once per month, we add up all the claims, fees, and stop-loss insurance premiums and take that amount out of your account. If your expenses turn out to be less than the amount you deposited, great. That extra money stays in your account. At the end of your contract period, if your expenses are more than what is in your account, we only take what’s available – your stop-loss insurance* covers the rest.

Get Money Back

If there’s money left over in your account when we settle for a given contract period, you’ll get to keep a chunk of it. Think of it as a bonus for being healthy. Highmark will retain a portion of this remainder as a deferred administrative fee.


Is Balanced Funding right for my business?

There are three things you should consider before you sign up for this product:

  1. Your employees’ health – The healthier they are, the fewer claims they’ll make and less risk to your cash flow.
  2. The size of your workforce – This plan works best with a stable workforce. If you are planning to expand or downsize, then this may not be the best fit for you.
  3. How much information you want – Summary reporting is great for getting insights into your employees’ health and can help you get the most from your health care dollars.

More flexibility for you, same great care for them

Your employees have access to a wide-variety of tools, programs, and services, like:

  • Virtual medicine – They can talk to a doctor from a mobile device.
  • No referrals – No hoops or hoopla, they can see any in-network doctor they want.
  • My Care Navigator – We can help find doctors and set up appointments.
  • Well 360 – A great program to help your employees reach their health goals.
  • Blues On Call – Talk to a nurse, 24/7.

Let's talk about Balanced Funding

Want to know more?

Businesses with 15 – 50 employees:

Highmark Sales Executive, Client Manager or Authorized Highmark Producer who specializes in small businesses can help you determine if Balanced Funding is the right fit for you.

Businesses with 51 or more employees:

Your Highmark representative can talk to you about Balanced Funding and if it’s right for your company.

Blues On Call is a service mark of the Blue Cross Blue Shield Association.

*Fixed monthly payments are based on the number of employees participating each month.

**Stop-loss coverage is provided solely by a separate company, HM Life Insurance Group. HM Life Insurance Company does not provide Blue Cross and/or Blue Shield products or services and is solely responsible for the stop-loss insurance coverage.

Health benefits or health benefit administration may be provided by or through Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company or Highmark Coverage Advantage, all of which are independent licensees of the Blue Cross Blue Shield Association.