Allied National Group Health Plans in Illinois

Allied National is a specialty health insurance administrator that has built its business around an often underserved market: small employers with 2 to 50 employees who want a self-funded plan’s flexibility and cost transparency without the administrative complexity typically associated with self-funding. Allied National’s Illinois presence makes it a viable alternative to traditional fully insured carriers for small business owners who feel they are paying too much in fully insured premiums and want more control over their benefit design.

Allied National’s Small Group Self-Funded Model

Allied National operates as a third-party administrator (TPA) for self-funded health plans serving small employers. Unlike traditional fully insured carriers, Allied National does not assume insurance risk itself. Instead, it administers the plan on behalf of the employer, which pays claims from a dedicated claims account, and arranges stop-loss insurance to cap the employer’s financial exposure. Key structural elements include:

• Self-funded plan structure: The employer technically funds and pays all claims, governed by ERISA, which means Illinois state insurance mandates generally do not apply
• Allied National TPA administration: Claims processing, member ID cards, EOBs, provider network access, and customer service handled by Allied National
• Stop-loss insurance: Specific stop-loss (per individual) and aggregate stop-loss (total group) arranged through Allied National to protect the employer from catastrophic claims
• Provider network access: Allied National provides access to major provider networks in Illinois including PHCS/Multiplan, giving employees access to a broad panel of in-network physicians and hospitals

Flexible Plan Design

One of Allied National’s primary advantages is the flexibility to design a health plan that matches your specific business needs rather than selecting from a carrier’s pre-built menu of plan options. Employers working with Allied National can customize:

• Deductible amounts (individual and family)
• Coinsurance percentages and out-of-pocket maximums
• Copay structures for office visits, urgent care, and ER
• In-network vs. out-of-network cost-sharing differentials
• Prescription drug benefit design and formulary tier structure
• Whether to include or exclude certain optional benefits (dental, vision, mental health, chiropractic)

This flexibility is particularly valuable for employers in industries with specific workforce characteristics — for example, a restaurant group that wants generous urgent care benefits for food service employees or a construction contractor that wants enhanced occupational therapy and physical therapy coverage.

Illinois Industries Allied National Serves Well

Allied National has established a strong track record with several Illinois employer segments:

• Restaurants and food service businesses (groups of 5–30 employees)
• Small retail operations and boutique shops
• Construction contractors and trade businesses
• Auto dealerships and repair shops
• Small professional services firms (2–15 employees) that don’t qualify for large-group plans

These industries often employ workforces where traditional fully insured premiums feel disproportionately high relative to employees’ actual medical utilization. Allied National’s self-funded model captures that efficiency.

How Allied National Stop-Loss Works

Stop-loss insurance is essential to any self-funded arrangement, and Allied National arranges both types:

• Specific stop-loss: Once any single covered individual’s claims exceed the specific deductible (typically $20,000–$60,000 per person), the stop-loss carrier reimburses the employer for 100% of claims above that threshold for the remainder of the plan year.
• Aggregate stop-loss: If the group’s total claims for the year exceed 125% (or another agreed-upon corridor) of expected claims, the aggregate stop-loss carrier covers the excess. This prevents a catastrophic group-wide claims year from threatening business cash flow.

Annual Claims Reporting

Allied National provides Illinois employers with detailed annual claims reports that break down medical and pharmacy spending by service category. This data helps employers identify cost drivers, evaluate plan design changes, and negotiate more informed stop-loss renewals. The transparency of this reporting is a significant improvement over the opaque renewal process typical of fully insured small group plans. Contact Illinois Health Agents for current Allied National quotes for your Illinois group.