Providers – Eligibility and Claim Status


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I'm new to self-funding, can UltraBenefits help me better understand how self-funding works and why it might be a good option for my clients?

Yes - we believe in the value that self-funding brings to clients and are always eager to help our broker partners be in the best position to offer their clients solutions that will work for them over the long-term. If you're new to self-funding you can reach out directly to our CEO, Jim Bushey, who will personally help you get the information you need. You can reach him via email at

Why choose UltraBenefits over other TPAs?

We're constantly evolving to meet the needs of our clients. Our localized expertise, in-house offerings, and excellent customer service help drive strong value resulting in high client retention.

Can UltraBenefits support me in renewal discussions with clients?

Yes - we know self-funding can be confusing, especially for first-time clients. We're here to help educate clients and co-sell with brokers as requested.

Does UltraBenefits work with brokers to deliver self-funded healthcare options to employers?

Yes- UltraBenefits feels strongly in offering design and administration of self-funded healthcare plans together with a client's broker.

How can I get in touch with UltraBenefits?

If you're new to UltraBenefits and the services we offer to clients who are self-funded or are considering self-funding, we'd love to connect to share what makes us unique among other TPAs. You can either reach out via our customer service team or directly to our CEO, Jim Bushey, via email


How can I determine a member's active status?

To check if a member is currently active, please login to your provider portal. Navigate to the "Eligibility" tab, where you can search for members using their ID or SSN. Alternatively, you can select "View All Eligible Members" and scroll through the list until you find the member in question.

How can I inquire about the status of a claim?

After logging into your provider portal, go to the "Claims" tab. You can utilize the search function to locate a specific claim or select "View All Claims" and click on the claim you wish to check.

How can I verify a member's benefits?

For any questions regarding eligibility you can reach out directly to our eligibility team via our Contact Us page.

How can I make modifications or additions to my benefits plan? Where can I access reports?

To make changes to your benefits plan, please login to your provider portal and navigate to the "HR Enrollment" tab. From there, you can enroll in new benefits, make adjustments, or submit a termination notice if necessary.

Reports are available on your provider portal. Simply login and visit the "Reports" tab. These reports are typically added mid-month and can be found there for your review.


How can I access information about my adult dependent's claims?

Login to the member portal and visit the "Claims" tab. You can use the search function to find a specific claim or choose "View All Claims" to see a list of claims. Click on the claim you wish to view for detailed information.

How can I check my deductible status?

When logged into your member portal, navigate to the "Reports" tab. Access your "Summary of Benefits Paid" to see an overview of your deductible status, including the amount you have paid and the remaining balance.

How can I review my Rx formulary?

Go to the "Eligibility" tab in your member portal to review the Rx formulary for yourself and your dependents. It contains essential information about prescription drug coverage.

How can I find a healthcare provider?

Visit and click on "Locate a Provider". Choose "First Health Network" and use the search engine to find a healthcare provider that meets your needs.

Where can I access my Explanation of Benefits (EOB)?

Since After logging into your member portal, go to the "Home" tab. Within your Medical Plan Document on this page, you can access your Explanation of Benefits (EOB) for detailed information on your claims and coverage.


What is a self-funded health plan?

A self-funded plan is a health care benefits package where the employer takes on the financial risk. Usually this means setting up a trust fund that holds money for both employers and employees to cover claims. With greater control over cash flow and budgeting, sponsors can manage their assets better for greater savings and profits. They can receive more benefit options and determine certain administrative responsibilities. Self-funding gives them protection and ensures they are responsible for covering care and receive certain advantages as well as state sponsored trust funds in the United States.

How many people receive coverage through self-insured health plans?

Between 1999 and 2020, the percentage of employers offering self-funded health plans for their employees rose from 44% to record high of 67%. This type of plan gives businesses more control over how they manage their healthcare expenses - instead of purchasing insurance, employers use their own assets to cover certain care benefits for workers. The savings made by doing this can be used towards greater profits or additional budgeting, as well as ensuring fixed premiums and administrative costs are kept to a minimum. Self-funded plans also give sponsors more responsibility when it comes to protecting their workers' medical, while allowing states to determine which services should be covered.

Why do employers self-fund their health plans?

There are several reasons why employers choose the self-funded option. The following are the most common reasons:

  • Self-funded plans offer a multitude of benefits to employers, including the ability to customize their health plan to the needs of their workforce.
  • Employers can manage and control their own funds and receive greater returns on investments than insurance carriers do.
  • Companies don't have to pay premiums in advance which helps them maintain a healthier budget
  • These types of policies are regulated under federal law (ERISA), so employers aren't subject to conflicting state mandates or taxes
  • With self-funding, employers can determine which care provider best suits their employees' needs and ensure adequate coverage is provided

Is self-funded insurance the best option for every employer?

Not always. A self-funded employer takes on the responsibility of paying for their employees' health care costs. This means they need financial assets to pay these unpredictable expenses. Therefore, small businesses or those with limited cash flow may not find self-insurance a feasible option. However, it should be known that there are companies as small as 25 employees who can effectively manage self-insured plans and receive greater benefits like cost-savings, budget control, and administrative freedom.

The trust sponsor has more autonomy in determining which health care coverage options best suit their needs and receive protection from certain state laws and regulations.

What about payroll deductions?

Employees make payments for their coverage through the employer's payroll department. Instead of being sent to an insurance provider for premiums, the money is kept by the employer until claims become due and payable or if it will be used as reserves, it goes into a tax-free trust that the employer controls. This type of self-funded plan offers many advantages, such as greater control over benefit budgets, cash flow management and increased profits. The responsible sponsor can also determine certain care options while ensuring protection of assets and receiving fixed cost savings on administration.

With what laws must self-insured group health plans comply?

A self-funded group health plan gives you a greater degree of control over your benefits and cash flow, as well as the ability to manage certain assets. It also allows you to receive savings on premiums and potentially generate more profit than traditional plans. As an administrator or sponsor, it's your responsibility to determine what care is covered and ensure the plan meets all applicable federal laws. This will help protect your employees while providing cost savings and greater administrative flexibility.