Self-funded options
Self-funded health plans, explained.
A self-funded plan means the employer funds its own claims directly, with stop-loss insurance protecting against the large ones, rather than paying a carrier one all-in premium to take on the whole risk. For the right group it offers real visibility and control. For the wrong group it is not worth it, and we will say so.
How it works
The idea, in plain English
You fund your own claims
Rather than paying a carrier one all-in premium to cover every claim, your plan pays employees' claims as they come, with a fixed stop-loss premium covering the large ones. You are paying for your group's actual use rather than an estimate built with a margin on top.
Insurance protects the large claims
Stop-loss coverage caps your exposure, on any single large claim and across the plan as a whole, so a bad year does not become an open-ended risk.
You get real visibility
For the first time you can see what is actually driving your spend. A fully-insured renewal hides that, and visibility is what makes it possible to manage cost instead of just absorbing it.
It is a multi-year strategy
The advantage compounds. Once there is data, decisions get sharper each year, which is why self-funding rewards employers who plan over several years rather than shopping one year at a time.
Who it fits, and who it does not
It can fit employers who
- Want to manage their health spend the way they manage every other major cost.
- Think in multi-year terms instead of shopping the plan one year at a time.
- Want visibility and control, and can fund the plan for it, whether at a steady monthly amount or with some month-to-month variation.
It is usually not the right move when
- The only goal is the lowest possible price this year.
- The appetite is to set benefits and not think about them again.
- The group is not yet ready to plan over several years.
There is real mechanics behind how self-funding controls cost and manages risk. When it looks like a fit, we walk through all of it with you, plainly, before anyone commits to anything.
Common questions
Common questions
- Is self-funding worth it for a mid-size company?
- It can be, for the right group. Self-funding rewards employers who think in multi-year terms and want direct visibility into and control over their plan. It is not the cheapest option every single year, and it is not for everyone. We will tell you whether it fits.
- How do I know if self-funding fits my company?
- It comes down to mindset more than size: a willingness to manage your plan like any other major cost and plan over a few years rather than one. Month-to-month cost can be steadied by how the plan is funded, so it is not always variable, and the best first step is a conversation about your specific situation.
- What is the difference between self-funded and level-funded?
- Level-funding is a middle path. You pay a set monthly amount that covers expected claims, stop-loss insurance, and administration, and you may get some money back if claims come in low, though some products refund only part of an unused claims fund. It usually comes with a limited set of pre-designed plan options and less flexibility than full self-funding, in exchange for steadier monthly cost. We help you compare both against your current plan.
- Is self-funding only for large employers?
- No. It is less about size and more about mindset and fit. Employers who want visibility and are willing to think in multi-year terms can be good candidates well below the size most people assume. We give you a clear read for your specific group.
See if self-funding fits your group.
Tell us about your company and we will give you a clear read on whether self-funding is worth exploring. A review costs nothing.