Before you count on any McLaren wellness feature, confirm whether your group is fully insured or self-funded.
McLaren Health Plan sells two different products to employers, and its wellness material does not say the features are identical across them. Funding is the first question to settle.
What the program is and what members do.
Fully insured plans
McLaren Health Plan says it offers fully insured plans to small and large group employers on HMO, point-of-service and high-deductible platforms. In a fully insured plan the employer pays a premium that McLaren says is fixed for a year and based on the number of employees enrolled each month. Wellness features come with the carrier’s product.
Self-funded plans through Health Advantage
McLaren Health Advantage is described as a wholly owned subsidiary of McLaren Health Plan and a Michigan third-party administrator. McLaren says it administers self-funded products, also called administrative services only plans, for employer groups with 50 or more employees. The employer carries the claims risk and the administrator processes claims.
What the published wellness material says
The McLaren Health Plan wellness page describes self-management tools, health system events and a nurse line. The Health Advantage member page describes a PPO that integrates preventive services and disease management programs. McLaren does not publish a side-by-side list showing which wellness features belong to which product, so differences must be confirmed directly.
Eligibility, funding and plan design.
Who the products are written for
McLaren says small group plans are for employers with 50 or fewer employees and large group plans are for employers with 51 or more full-time equivalent employees. Its self-funded administration is described for groups with 50 or more employees. Small group plans may be bought on the Marketplace or directly from McLaren.
How funding changes the wellness answer
Wellness features can differ between the fully insured and self-funded products. In practice a fully insured group buys what the carrier packages, while a self-funded group has more room to add or swap vendors. McLaren publishes no menu of optional wellness riders, so none should be assumed.
Where it fits in plan design
Funding is a plan design decision that should come before any wellness conversation. A group weighing a move between fully insured and self-funded should treat wellness as a secondary factor, because McLaren’s published material is light on rewards and incentives compared with the larger carriers.
What to settle before relying on it.
Which product is our group actually on?
Confirm in writing whether the group is on a fully insured McLaren Health Plan product or a Health Advantage self-funded plan. Renewal paperwork sometimes blurs the two. Every wellness question that follows depends on this answer, so we would settle it first.
Which wellness features are in our contract?
Ask McLaren to list the wellness, nurse line and care management services that apply to this group’s contract, by product. Published web pages describe the member experience, not contract terms. Get the list from the carrier and keep it with the renewal file.
Would a different funding model change what we can add?
If the group is large enough for self-funding, ask what vendors can be layered on and who pays. If the group is small, ask whether McLaren sells any add-on at all. A rewards program of any kind raises HIPAA, ACA, ADA and GINA questions, so have employment counsel review the design.
Common questions about this program.
Does McLaren sell the same wellness features to fully insured and self-funded groups?
McLaren does not publish a comparison. Its published pages describe self-management tools, events and care management for the plan, and a PPO with disease management for Health Advantage. Ask the carrier for a feature list by product.
What size group can use McLaren Health Advantage?
McLaren says Health Advantage administers self-funded products for employer groups with 50 or more employees. Whether a specific group qualifies, and on what terms, is a carrier underwriting question.
Can a small employer buy McLaren coverage?
McLaren says small group plans are for employers with 50 or fewer employees and are on the HMO platform, available on the Marketplace or directly. Large group plans, for 51 or more full-time equivalent employees, are on HMO, point-of-service and high-deductible platforms.
Where these details come from.
This page summarizes what McLaren Health Plan publishes. Programs change, so confirm current details with the carrier before relying on them.
mclaren.org → mclarenhealthplan.org → mclarenhealthplan.org →
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Contribution split by tier
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