Maximum Control and Savings with Self-Funded Insurance
Take control of your healthcare costs and plan design. Self-funded plans eliminate carrier profit margins while providing transparency, flexibility, and significant cost savings for your business.
Self-Funded Benefits
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20-40% Cost Savings
Eliminate carrier profit and risk charges
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Complete Control
Design plans that fit your workforce
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Full Transparency
See exactly where every dollar goes
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Cash Flow Advantages
Pay claims as incurred, not in advance
Trusted by Fortune 500 companies
How Self-Funding Works
Understanding the self-funded model empowers you to make informed decisions about your company's healthcare benefits strategy.
You Establish a Claims Fund
Set aside funds to pay employee medical claims as they occur, based on historical data and actuarial projections.
Purchase Stop-Loss Insurance
Protect against catastrophic claims with specific and aggregate stop-loss coverage.
Partner with a TPA
Third-party administrator handles claims processing, network access, and member services.
Pay Claims Directly
You pay actual claims as they're incurred, gaining cash flow advantages and complete cost transparency.
Cost Breakdown
Compare to Fully Funded:
- • No carrier profit margin (5-10%)
- • No premium taxes (2-3%)
- • No risk charges (3-5%)
- Total Savings: 20-40%
Self-Funded Advantages
Significant Savings
Eliminate carrier profit margins, premium taxes, and risk charges. Most employers save 20-40% compared to fully funded plans.
- ✓ No carrier profit (5-10%)
- ✓ No premium taxes (2-3%)
- ✓ No risk charges (3-5%)
- ✓ Lower admin costs
Complete Transparency
See exactly where every healthcare dollar goes. Detailed claims data helps you identify trends and opportunities.
- ✓ Real-time claims reporting
- ✓ Cost center analysis
- ✓ Utilization patterns
- ✓ Vendor performance data
Design Flexibility
Customize your plan to match your workforce needs. Change benefits, networks, and vendors without carrier restrictions.
- ✓ Custom plan design
- ✓ Network selection
- ✓ Vendor choice
- ✓ Mid-year changes possible
Cash Flow Benefits
Pay claims as incurred rather than in advance. Earn interest on reserves and improve working capital position.
- ✓ Claims paid in arrears
- ✓ Interest earnings on reserves
- ✓ Better cash utilization
- ✓ Improved balance sheet
ERISA Protection
Self-funded plans fall under federal ERISA law, preempting most state insurance mandates and regulations.
- ✓ Federal law protection
- ✓ Fewer state mandates
- ✓ Uniform administration
- ✓ Legal protections
Data-Driven Decisions
Access detailed analytics to make informed decisions about wellness programs, plan changes, and cost management.
- ✓ Predictive analytics
- ✓ Trend identification
- ✓ ROI measurement
- ✓ Strategic planning data
Stop-Loss Protection
Stop-loss insurance protects your business from unexpected high claims while allowing you to retain the cost savings of self-funding.
Specific Stop-Loss
Protects against high individual claims
Covers claims for a single individual that exceed your specific deductible (typically $50,000 - $250,000 per person per year).
Example:
Deductible: $75,000
Employee's claim: $500,000
You pay: $75,000
Stop-loss pays: $425,000
Aggregate Stop-Loss
Protects against total claims exceeding expectations
Covers when your total annual claims exceed a predetermined threshold (typically 120-125% of expected claims).
Example:
Expected claims: $1,000,000
Aggregate attachment: $1,250,000
Actual claims: $1,500,000
You pay: $1,250,000
Stop-loss pays: $250,000
Is Self-Funding Right for You?
Ideal Candidates:
- Businesses with 100+ employees
- Companies with healthy employee populations
- Organizations with strong cash reserves
- Employers wanting complete cost transparency
- Businesses seeking maximum plan flexibility
- Companies comfortable assuming some risk
Success Factors:
- Adequate cash flow and reserves
- Experienced HR/benefits team
- Strong broker/consultant partnership
- Quality TPA and stop-loss carrier
- Robust wellness and disease management
- Data analytics capabilities
Ready to Take Control of Your Healthcare Costs?
Discover if self-funding could save your business 20-40% on healthcare costs. Our self-funding experts will analyze your situation and provide a comprehensive feasibility study.