Optimyl Benefits is a level funded health plan program built specifically for small and mid-size employers. Optimyl packages medical and dental coverage for groups of roughly 2 to 300 employees into a single turnkey arrangement: plan administration through Allied Benefit Systems, one of the largest independent third-party administrators in the country, stop-loss protection from an A (Excellent) rated carrier, and a choice of network and pharmacy options. For Illinois employers who want more flexibility and transparency than a fully insured renewal offers, Optimyl is one of the most customizable level funded programs on the market.
How Optimyl’s Level Funded Structure Works
With Optimyl your business pays one fixed monthly amount that does not change during the plan year. That payment covers three things: your claims fund, stop-loss insurance, and administrative fees. Claims are paid out of the claims fund, and if claims ever run ahead of the funding, stop-loss advances the money so your cash flow stays level. If your group’s claims come in lower than expected, you are eligible for a refund of unused claim funds after the plan year’s runout period. Depending on the option you choose, that refund can be 50% to 100% of the surplus. Stop-loss coverage is underwritten by The North River Insurance Company (part of Crum & Forster) or Gerber Life Insurance Company, depending on state.
Optimyl Plan and Network Options
Rather than a short menu of fixed plans, Optimyl lets employers build a design around their budget. Deductibles, coinsurance, copays, and pharmacy tiers are all adjustable, HSA-qualified designs are available, and every option is built to meet Affordable Care Act requirements. The biggest lever is the network type:
| Network Type | How It Works | Savings vs. PPO |
|---|---|---|
| PPO | Broad national network with out-of-network coverage at higher cost sharing | Baseline |
| EPO | Broad national network, no out-of-network coverage except emergencies | Some savings |
| Local High-Performance | Narrower network built around one or two hospital systems | Significant savings |
| RBP Hybrid | Reference-based pricing for facilities, broad network for physicians | Moderate to strong savings |
| Reference-Based Pricing | Providers paid a set multiple of Medicare rates, members can see any provider | Strongest savings |
Exact plan designs, network availability, and minimum group sizes depend on your ZIP code and census and are confirmed at quote.
What’s Included With Optimyl
- Integrated dental: Level funded dental can be bundled with the medical plan, so one bill and one administrator handle both.
- VSP vision: Fully insured vision plans underwritten by VSP are available and billed together with medical and dental.
- Top-tier pharmacy benefits: Pharmacy options include the CVS and Cigna PBMs, with a choice to pass 0%, 50%, or 100% of Rx rebates back to the plan.
- Virtual care: Teladoc virtual visits are included, with a per-visit cost on HSA-qualified plans.
- Plan performance reporting: Employers see how claims are running against the funded amount, including pharmacy rebate detail, so renewals are based on your actual experience.
- Dedicated service: Optimyl provides dedicated pre-sale and post-sale support and works with its own online tools, third-party benefits platforms such as Employee Navigator, or paper enrollment.
What Type of Companies Optimyl Is Good For
Optimyl tends to be the strongest fit for:
- Small Illinois employers, including groups as small as 2 employees, that want to move off a fully insured plan and keep any claims savings
- Employers with a relatively healthy workforce that stands to earn a surplus refund at year end
- Cost-focused groups willing to consider a local high-performance network or reference-based pricing to lower premiums
- Businesses that want dental and vision bundled with medical under one bill
Optimyl is generally a weaker fit for groups with several ongoing high-cost claims, which can price less favorably under level funded underwriting, and for employers whose employees are unwilling to accept any network trade-offs. Reference-based pricing in particular works best when members are comfortable with the extra provider guidance it involves. Plan availability, group size limits, and stop-loss options vary by state, so contact Illinois Health Agents to confirm current Optimyl availability for your group and compare it side by side with other level funded carriers.
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