Level Funded Plans

Predictable Costs with Savings Potential through Level Funded Insurance

Get the stability of traditional insurance with the cost-saving potential of self-funding. Level funded plans offer predictable monthly costs, claims transparency, and potential premium refunds.

Level Funded Advantages

  • Predictable Payments

    Fixed monthly costs for budgeting

  • Potential Refunds

    Get money back for good claims experience

  • Claims Transparency

    See your actual claims data and trends

  • Stop-Loss Protection

    Protected from catastrophic claims

Save an average of 10-20% vs fully funded

How Level Funding Works

Level funded plans combine the best aspects of fully funded and self-funded insurance to provide predictability with upside potential.

Claims Fund

Expected claims costs based on your group demographics

Stop-Loss Premium

Insurance protection for claims exceeding expectations

Admin Fees

TPA services, network access, and plan management

Your Fixed Monthly Payment = Claims Fund + Stop-Loss + Admin Fees

If Claims Are Low

You receive a refund at year-end!

When your group's actual claims are lower than the claims fund you paid into, you receive a premium refund. Many employers see refunds of 10-30% of their annual premium.

Example:

Claims Fund Paid: $100,000

Actual Claims: $75,000

Refund: $25,000

If Claims Are High

You're protected by stop-loss!

When claims exceed your claims fund, stop-loss insurance kicks in to cover the excess. Your costs never exceed your fixed monthly payments.

Example:

Claims Fund Paid: $100,000

Actual Claims: $150,000

Your Cost: $100,000 (stop-loss pays $50k)

Best of Both Worlds

Level funded plans combine the advantages of fully funded and self-funded approaches.

Feature Fully Funded Level Funded Self-Funded
Predictable Costs
Potential Refunds
Claims Transparency
Risk Protection Partial
Easy Administration Complex
Cost Savings Potential Low Medium-High High

Is Level Funding Right for You?

Perfect For:

  • Businesses with 25-200 employees
  • Companies with healthy employee populations
  • Employers frustrated with annual rate increases
  • Organizations wanting claims visibility
  • Businesses ready for more control
  • Companies seeking cost reduction opportunities

Key Benefits:

  • Average savings of 10-20% vs fully funded
  • Cash flow stability with refund potential
  • Complete claims data transparency
  • No surprise mid-year assessments
  • Easier transition to full self-funding later
  • Potential PEPM rates under $500

Ready to Explore Level Funding?

Discover how much you could save with a level funded plan. Our group benefits specialists will analyze your current plan and show you the potential savings and refund opportunities.

Common Questions

Level Funded Insurance FAQ

Common questions about level funded group health plans

Get answers about level funded insurance and how it combines the best of fully funded and self-funded plans.

What is a level funded health plan?

A level funded plan is a hybrid approach that combines aspects of fully funded and self-funded insurance. Employers pay a fixed monthly amount that includes expected claims, stop-loss protection, and administrative fees, but may receive refunds if claims are lower than expected.

How does level funding differ from traditional insurance?

Unlike fully funded plans where you never see your claims data or get refunds, level funded plans provide transparency into your group's claims experience and potential premium refunds for favorable claims. You pay predictable monthly amounts like fully funded, but have upside potential like self-funding.

What happens if claims exceed expectations?

Level funded plans include stop-loss insurance that protects you if claims exceed expected amounts. Your maximum exposure is limited to your fixed monthly payments, so you're protected from catastrophic claims while still benefiting from good claims experience.

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