What is a Self-Funded Plan?

With a self-funded plan, you keep the risks and rewards of paying for your employees' healthcare. In comparison, fully-insured plans pass the risk and rewards on to the insurance company in exchange for a fixed premium.

Save Money

Companies that choose self-funding have the opportunity to save money when plan participants have few claims and few expensive illnesses.

Stop-Loss Coverage

We offer additional stop-loss coverage to protect your business during periods of high medical claim expenses. This provides financial security by allowing you to set a yearly guaranteed annual plan maximum cost for your business.

Specific stop-loss coverage limits the plan’s financial exposure on any one individual. Aggregate stop-loss limits the plan’s financial liability for all eligible plan participants.

Managing Your Plan

We make self-funding easier for you by coordinating essential services, like:

  • Claims Administration
  • Medical Management
  • Pharmacy Benefits

Plus, we provide clear reports and documentation of how every dollar is spent, helping you manage the plan effectively.

Your business owns all the data associated with your plan participants, and usage. You can see claims info, medical history, and more. This allows for smarter and more agile planning for future healthcare costs.

Self-Funded vs. Fully Insured

Most self-funded plans are not subject to the taxes and fees that apply to fully insured plans. Businesses have the potential to save money when claims are lower than expected. Most plans follow federal ERISA rules and are not subject to most state mandates*, like bariatric surgery. 

*If your plan is not governed by ERISA, some state mandates may apply.

Fully-insured plans are subject to taxes and fees. Businesses pay the insurance company a fixed rate, no matter if claims are high or low. Fully-insured plans are subject to all state mandates.