Self-Funded Health Plan Consulting for Employers
Albuquerque, Fort Scott, Overland Park, Phoenix, St. Joseph

Many employers are exploring self-funded insurance options as an alternative to traditional fully insured plans. Self-funding can offer greater transparency into health care costs and more insight into how benefit dollars are spent.

The opportunity comes with additional responsibility. Understanding risk exposure, stop-loss options, and claims performance is essential before making a funding decision.

Leavitt Strategic Benefits helps employers evaluate self-funded, level-funded, and fully insured health plans so they can make informed decisions that support their employees and business goals.

What Is a Self-Funded Health Plan?

A self-funded health plan, also known as a self-insured health plan, allows employers to pay employee health care claims directly as they occur rather than paying a fixed premium to an insurance carrier for all claim costs.

Most self-funded plans include:

• Claims administration through a third-party administrator (TPA)
• Provider network access
• Pharmacy benefit management
• Stop-loss insurance to help limit financial risk

Self-funding gives employers more visibility into how health care dollars are spent and creates opportunities to customize benefits based on workforce needs.

Self-Funded vs. Fully Insured Health Plans

Understanding the differences between funding arrangements is an important first step.

Fully Insured Health Plans

With a fully insured plan:

• Employers pay a fixed monthly premium
• The insurance company assumes claims risk
• Costs are generally predictable from month to month
• Employers have limited access to detailed claims data

Self-Funded Health Plans

With a self-funded plan:

• Employers fund actual health care claims
• Costs fluctuate based on claims experience
• Employers gain access to claims and utilization data
• Plan designs can often be tailored to business objectives

The right funding arrangement depends on factors such as company size, financial goals, workforce demographics, and risk tolerance.

Is Self-Funding Right for Your Business?

A self-funded health plan may be worth exploring if your organization:

• Has a stable employee population
• Wants greater health care cost transparency
• Seeks more flexibility in benefit design
• Is interested in using claims data to guide decisions
• Wants to evaluate alternatives to traditional insurance premiums

Not every employer is a candidate for self-funding. This funding approach is often evaluated by mid-sized and large employers, although some smaller organizations may also explore self-funded or level-funded arrangements based on workforce size, financial resources, and risk tolerance. A detailed analysis can help determine whether the potential rewards align with the risks.

Stop-Loss Insurance for Self-Funded Employers

Stop-loss insurance plays a critical role in most self-funded arrangements by helping protect employers from unexpectedly large claims.

Key considerations include:

• Specific stop-loss deductibles
• Aggregate stop-loss protection
• Contract provisions
• Carrier financial strength
• Renewal history and pricing trends

The right stop-loss strategy can help balance risk management and cost control.

Claims Analysis and Cost Drivers

One of the primary advantages of self-funding is access to meaningful health care data. Claims analysis can help employers better understand:

• High-cost claims categories
• Chronic condition trends
• Emergency room utilization
• Pharmacy spending patterns
• Preventive care participation
• Opportunities for population health improvement

These insights can support more strategic decisions about plan design, workforce health initiatives, and employee benefits investments.

Historical claims data can also help employers identify cost drivers, model future health care expenses, and evaluate the potential financial impact of transitioning from a fully insured plan to a self-funded arrangement.

Level-Funded Health Plans: A Middle Ground

For employers interested in greater control without assuming the full financial risk of self-funding, level-funded health plans may offer an alternative.

Level-funded plans typically include:

• Fixed monthly payments
• Administrative services
• Stop-loss protection
• Potential surplus returns when claims are lower than expected

Many employers use level-funded health plans to explore self-funding while maintaining a more predictable budgeting approach.

How Leavitt Strategic Benefits Helps Employers Evaluate Funding Options

Choosing a health plan funding strategy requires more than comparing premiums.

Leavitt Strategic Benefits helps employers evaluate:

• Self-funded health plans
• Self-insured employee benefit strategies
• Level-funded health plans
• Fully insured alternatives
• Stop-loss insurance options
• Claims experience and cost trends
• Long-term health care cost projections

Our approach focuses on helping employers understand both financial risk and employee impact so they can make confident, informed decisions.

Explore Your Funding Options

Every organization has unique goals, challenges, and risk considerations.

Whether you are considering self-funding for the first time, reviewing a level-funded arrangement, or comparing alternatives to a fully insured plan, Leavitt Strategic Benefits can help you evaluate your options and identify a path that aligns with your business objectives.

Schedule a conversation with a Leavitt Strategic Benefits advisor to evaluate self-funded, level-funded, and fully insured health plan options.