Frequently Asked Questions & Glossaries
Answers to your questions, definitions and more.
Unlike many others in the healthcare and insurance space, we want you to understand 100% of your plan, benefits and everything else involving your healthcare. You’ll find answers to many of our commonly asked questions below, as well as helpful glossaries.
If you don’t find the question – or answer – you need, please don’t hesitate to contact us.
Glossaries
Health Benefits Glossary
Glossary of Terms for Employer Benefit Plans
ACA Uniform Glossary
ACA Mandated Uniform Glossary
Self-Funding 101 & Stop-Loss 101
Self-Funding and Stop-Loss Explanations
What is self-funding?
A self-funded (or self-insured) plan is one in which the employer assumes the financial risk for providing health care benefits to its employees. In practical terms, self-insured employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a fully insured plan.
Learn more about self-funding by reviewing our Self-Funding 101.
What is KPPFree™?
We have invented a way to allow self-funded employers to connect with low cost, high quality, free-market-minded providers, no matter who provides primary TPA services for the health plan.
KPPFree™ includes providers who believe in free-market transparency the idea that value is a balance between cost and quality. They offer our self-funded employer clients their best price because they want to work directly with employers in their community.
What plan designs can you support / administer?
We offer administration for:
- Traditional self-funded benefit plans
- Plan administration and benefit designs based upon free-market principles
- Reference Based Pricing (RBP) benefit structures
- Level-Funded plans
We can administer any combination of these options, or offer you completely out-of-the-box solutions.
Contact us to learn more.
Do you take commissions?
No. Unlike most TPAs, the Kempton Group does not receive, or retain, a percentage of commission on your stop-loss policy, or any portion of subrogation recovery, PBM rebates or negotiated savings. PPO and other vendor fees are a direct pass-through cost to the client and are not included in the administrative fee.
What are your administrative fees?
The Kempton Group does not charge additional fees. All of our services are included in a single, flat administrative fee per-employee and per-month. Services outside of our standard administration are offered at a fixed, flat fee and quoted to you up-front.
What size group is a good fit for self-funding?
Smaller than you might think! We generally work with groups from 50-3000, but we have markets to fit almost any size group – from traditional self-funded benefit options to level-funded products. Typically, the best time to switch is when your group is healthiest.
What provider networks do you work with?
Please visit the Network Provider Directory section for the most up-to-date list of the PPO networks available.
Contact us if you do not see the network you are interested in.
What companies do you work with for reinsurance?
We have great relationships with many stop-loss carriers and MGUs.
Contact us to discuss your stop-loss needs.
What is the benefit of using a KPPFree™ Provider?
KPPFree™ pricing is bundled, upfront, and reasonable. Self-insurance guarantees a lower price point. When you utilize a Premier Provider, all of your out-of-pocket costs are waived. You will not be responsible for deductibles, copays or coinsurance. The physician’s services, anesthesiology and facility services are covered at 100% at no cost to you.
What if I need to travel for my KPPFree™ procedure?
Reasonable travel expenses are included. We will provide assistance with your travel arrangements, including lodging and reimbursement for fuel. Please contact us to discuss your travel needs.
What procedures are included?
Use the KPPFree™ app to see a full list of procedures and providers near you. With KPPFree™, nearly every procedure is available. If your physician has indicated you need a specific procedure or surgery that you do not see listed, please contact us! We’ll be more than happy to assist you in determining whether it can be performed with a KPPFree™ Provider.
Who are the KPPFree™ Providers?
Use the KPPFree™ app or the Location and Specialties Map to see a full list of procedures and providers near you.
Our Most Commonly Used Resources
These are Kempton’s most commonly used forms, handouts, guides and more.
Let's Talk
The Kempton Group is a family owned and operated organization, with real people here ready to help you. Get in touch. We’re eager to hear from you.
The Kempton Story
We’ve been around since 1969, but it hasn’t always been business as usual.
Schedule Consultation
The next step is to get together – via phone, Teams, or in-person – to discuss how the Kempton Group can work with you.