Self-Insured Health Plans

Employer-sponsored health insurance coverage for employees and dependents.

What is Self-Funding?

Self-funding is an arrangement where employer provides direct reimbursement for health benefits, with business funds—generally combined with stop-loss protection that protects against catastrophic health expenses.


Can yield significant savings with healthy workforce

Custom, flexible plan design

  • Allows for innovation

Direct control over medical inflation

Elimination of premium tax

Gain wellness plan ROI

Enhanced data and reporting


New strategies come with some inherent risk

Product marketplace not tightly regulated

  • Important to work with reliable, proven Stop-Loss carrier

Requires diligent financial planning

Large claim liability

Legal and financial responsibilities fall on
the employer

Requires greater employer involvement

Types of Self-Funding: Risk vs. Reward

Self-Funded Health Plans

Greatest Risk: Employer retains all control and risk exposure

Employer as Payor & Plan Sponsor


Level Funded Premiums


Benefit Captive or Reinsurance Purchasing Co-Op


Graded funding with specific Stop-loss and Aggregate Stop-Loss Reinsurance

Employer as Payor & Plan Sponsor

ASO with Aggregate Stop-loss Reinsurance only


Pure Self-Funding—ASO only

Fully-Insured Health Plans

Least Risk: 100% risk from employer to external

Employer as Funds Facilitator


Group Health Plans

Employer as Plan Selector & Designer

Fully-Insured with HRA

Fully Insured High Deductible Plan with Health Reimbursement Arrangement

Level-Funded Plans

Pay a steady amount each month, similar to fully-insured health plans

  • Determined by TPA or Carrier
  • Includes Stop-Loss Insurance
  • “Pools” the premiums, claims paid with this money
  • Remaining funds in the “pool” may be returned to the employer

Offers predictable, set cost like fully-insured plans with the benefits of a self- insured health plan

Least risk of all Self-Funded plan structures


Acts and feels like a fully-insured plan

Renewal costs solely determined by your company’s health care costs

Retain some (or all) of claims surplus

No State Premium Tax and excluded from 2 of 3 ACA fees

Generally less expensive than fully-Insured plans

Increased flexibility and customization of insurance plan design

What is Captive Insurance?

Captive insurance is similar to an “in-house” benefits plan and is set up as a wholly-owned subsidiary for companies. It is designed to cover assets and company risks.

Medical Captive Insurance Plans

Single Parent Plans

Large employer with existing captive or that is currently self-insured

  • Complete control over plan
  • Built for large amount of plan participants
  • Requires wide range of participants to assign risk and benchmark costs

Group Member Plans

Member groups without an existing captive

  • Built for small to mid-sized groups
  • Member-owners gain financial leverage withstop-loss coverage
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