Fully insured
The employer pays a carrier premium and the carrier assumes covered claims risk under the policy. State insurance rules, premium taxes, carrier retention, network, and renewal pricing remain part of the decision.
Health-plan funding strategies
Fully insured, level-funded, and self-funded health plans compared before risk moves
SSGI helps employers compare how each funding structure allocates claims risk, cash flow, administration, data access, stop-loss protection, and renewal responsibility. No model is automatically cheaper or better; the right evaluation uses the employer's size, claims credibility, risk tolerance, workforce, reserves, compliance capacity, and current market options.
Funding models
How the three primary structures differ
The governing contracts and current proposal control. Labels alone do not reveal maximum liability, exclusions, data rights, or renewal mechanics.
Level-funded
The employer usually pays a level monthly amount covering estimated claims, stop-loss, and administration. Understand aggregate and specific stop-loss, claim funding, runout, terminal liability, surplus treatment, and renewal calculation.
Self-funded
The employer funds covered claims and engages administrators and networks, commonly purchasing stop-loss to limit specified risk. Cash flow, reserves, fiduciary duties, documents, reporting, privacy, and vendor governance require real operational capacity.
Stop-loss protection
Specific and aggregate stop-loss generally protects the employer—not individual employees—from defined claim risk above contract thresholds. Lasers, exclusions, contract basis, run-in/runout, disclosure, and renewal terms matter.
Due diligence
Questions to answer before changing funding
A proposal should be tested under favorable, expected, and adverse scenarios—not judged by the first monthly payment alone.
Maximum annual liability
Identify the employer's maximum contractual exposure, monthly cash-flow requirements, stop-loss attachment points, exclusions, fees, and any liability extending beyond the plan year.
Claims data and credibility
Determine what credible claims, large-claim, demographic, and utilization information is available and how much weight it can reasonably carry for the group size.
Administration and compliance
Assign plan-document, eligibility, COBRA, claims, appeals, notices, reporting, privacy, fiduciary, and vendor-oversight responsibilities before implementation.
Employee disruption
Compare networks, formularies, plan designs, member services, ID cards, claims processes, and communications so a funding change is not mistaken for a benefit guarantee.
Renewal and exit provisions
Understand renewal methodology, stop-loss renewal, claims runout, terminal funding, data access, contract termination, and the practical path back to another arrangement.
Complete product coverage
Connect the local or strategic decision to the complete benefits portfolio
Medical, supporting benefits, funding, accounts, administration, ICHRA, and leave coordination should work as one program. These hubs carry the product detail so this page can remain focused and useful.
- Group medical and health insuranceTraditional group medical coverage, plan and network design, prescription benefits, employer contributions, renewals, and ICHRA comparison.Explore this coverage family
- Insurance carriers and plan insightsLaura Decker's independent guides compare carrier models, exact networks, employer plan structures, service areas, and implementation questions across SSGI's core markets.Explore this coverage family
- Dental, vision, life, disability, and voluntary benefitsGroup dental and vision, employer-paid or voluntary life and AD&D, short- and long-term disability, accident, critical illness, and hospital indemnity.Explore this coverage family
- HSA, FSA, HRA, QSEHRA, and Section 125Benefit-account and reimbursement strategy, including eligibility, employer funding, payroll treatment, employee communication, and administrator coordination.Explore this coverage family
- Fully insured, level-funded, and self-funded strategiesA disciplined comparison of risk, cash flow, stop-loss protection, claims reporting, administration, and renewal mechanics before changing funding.Explore this coverage family
- Administration, enrollment, COBRA, and year-round serviceEligibility, onboarding, terminations, billing, enrollment, employee questions, carrier and administrator coordination, and renewal execution.Explore this coverage family
Product availability, eligibility, underwriting, pricing, networks, funding, and recommendations depend on the employer, workforce, jurisdiction, carrier, and current market. SSGI coordinates with carriers, administrators, payroll providers, and the employer's legal and tax advisers; those parties retain their own responsibilities and authoritative records.
Frequently asked questions
Straight answers before the first employer review
General education only. Plan availability, pricing, eligibility, funding, networks, and recommendations depend on current employer and market facts.
Related guidance
Continue through the SSGI coverage center
Descriptive internal links connect this page to the next useful decision instead of repeating the same content under different URLs.
Educational information only; not legal, tax, accounting, medical, coverage, actuarial, or compliance advice. The public contact form is a HIPAA-compatible general-intake boundary, not a BAA-covered clinical, claims, underwriting, payroll, or account channel. Do not submit health information, claims, Medicare or policy numbers, Social Security numbers, member IDs, financial data, credentials, or employee-level census information.
Sources
- U.S. Department of Labor — Health PlansOfficial EBSA resources for employer health-plan administration and compliance.
- HealthCare.gov — Self-insured health planOfficial federal plain-language definition of a self-insured health plan.
- U.S. Department of Labor — Reporting and Disclosure GuideOfficial guide to common employee-benefit reporting and disclosure responsibilities.
Compare maximum risk, administration, and employee impact before price
Bring the current renewal, census-level business facts, available aggregate reporting, plan documents, fees, and leadership's risk and cash-flow parameters. Do not send claims or employee health information through the public form.