Coordination & Savings
MLR & Payer-of-Last-Resort for Tribal Self-Funded Plans
How Medicare-like rates, IHS/PRC, and payer-of-last-resort rules work together so outside coverage pays first and more Tribal dollars stay in the community.
Tribal Health Plans, Administered with Sovereignty in Mind
Summit’s Tribal TPA team is dedicated to self-funded health, dental, and vision programs for Tribal Nations. We combine technical expertise in plan design and claims administration with a deep respect for Tribal law, culture, and self-governance.
If you’d like a broader, non-Tribal primer on how self-funded plans work for employers in general, our parent company Summit Administration Services has a plain-language overview of self-funded health insurance. You can read it here: Self-Funded Health Insurance for Employers .
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Self-Funded Medical, Dental, & Vision
From PPO-style benefit plans to more customized arrangements, we handle day-to-day claims, eligibility, and coordination so your members experience smooth, predictable care.
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IHS & Tribal Clinic Coordination
We help align your self-funded plan with Indian Health Service and Tribal health facilities, so the plan, providers, and federal resources work together instead of at cross-purposes.
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Cost Management & Member Experience
Strategies like appropriate plan design, network selection, and stop-loss placement all matter. We work to balance financial stewardship with member access and cultural considerations.
Featured Insight: The Self-Funded Tribal Advantage
For many Tribal Nations, the biggest opportunity in health benefits is moving beyond fully insured arrangements into self-funded plans that deliberately coordinate with IHS. Done well, this can significantly reduce plan costs while preserving or improving access for members.
Our Self-Funded Tribal Advantage framework is built specifically for Tribal Nations and draws on experience with plan design, IHS billing, and the realities of administering benefits across Tribal governments and enterprises.
Topics we often explore with Tribal health plans:
- • When self-funding makes sense for your Nation
- • How IHS coordination can impact total plan cost
- • Structuring benefits for employees vs. Tribal members
- • Working alongside your current broker or consultant
- • Integrating Tribal clinics and local providers
Featured Tribal Health Strategies
Explore deeper dives into how Tribal self-funded plans coordinate with IHS, PRC, and stop-loss carriers to protect budgets while preserving sovereignty.
Budget Protection
Stop-Loss Insurance for Tribal Self-Funded Plans
How specific and aggregate stop-loss coverage cap catastrophic risk, and what underwriters want to see from Tribal plans that leverage IHS, PRC, and Medicare-like rates.
How Summit Fits into Your Tribal Health Strategy
Some Nations come to us with a clear vision and an advisor already in place. Others are still exploring whether self-funding is the right move. Our role as a Tribal-focused TPA is to meet you where you are and support the process, not to dictate it.
Working with Tribal Leadership
We collaborate with Councils, Boards, and leadership to explain options in plain language and connect benefit decisions to long-term Tribal priorities.
Working with Your Broker/Consultant
Summit is built to work alongside trusted advisors. We welcome partnerships with your current broker or consultant to implement the strategies you design together.
Working with Providers & Clinics
From Tribal clinics to regional hospitals, our claims and provider-relations teams focus on clear communication, accurate payments, and minimizing confusion for members.
When You’re Ready to Talk Details
As you explore self-funded options and IHS coordination, this Tribal Health section will grow with more examples, explanations, and practical guidance. When you’re ready to look at your Nation’s specific numbers, our team can prepare a focused, no-obligation review of your current plan.
Request a Free Plan Analysis
or simply keep reading and return here whenever the timing is right.