Know what you are carrying, and what the carrier is carrying.
Every group health plan divides financial risk between the employer and someone else. In a fully insured plan the carrier carries nearly all of it and charges for doing so. In a level-funded or self-funded arrangement the employer carries part of it and insures the rest through stop-loss coverage. That split is a decision, not a default, and it deserves a second look whenever the group changes. Our alternative funding and stop-loss page covers the mechanics.
Four places the risk sits.
The Carrier’s Share
What the carrier takes on, and what it charges to take it on. In a fully insured plan that charge is built into the premium and is hard to see.
Your Share
What the employer is exposed to if claims run high. It should be a number you have chosen, not one you discovered.
Stop-Loss Terms
Attachment points, the contract basis, and how a very large claim is treated at the next renewal. The details of the contract decide how protective it really is.
The Group Itself
Size, age, turnover and claims concentration. A group that has changed since the funding choice was made may be in the wrong arrangement.
Options compared on the same footing.
Compare the Structures
Fully insured, level-funded, self-funded with stop-loss and group captives are set side by side for your group, with what each asks of you in cash flow and in tolerance for a bad year.
Test the Protection
We read stop-loss and any pooling arrangements for what they exclude as well as what they cover, because the exclusions are where surprises live.
Match Risk to Appetite
The right answer depends on how much variability your finances and your leadership can absorb. We say so plainly, including when staying where you are is the right call.
Renewal and funding strategy · Fiduciary and governance services
The same four documents, and a conversation.
The renewal letter, your current plan summary, the contribution split by tier and the enrolled counts by tier. For a risk review we also want to hear how your leadership thinks about a bad year, since that decides which options are worth modeling.
Send your renewal · What changes at fifty employees
The other three lenses: Cost · Plan Performance · Administration
Three questions about risk.
The ones that come before any funding conversation.
Is fully insured always the safest choice?
It is the most predictable in a single year, because the carrier carries the risk. Predictability has a price, and the price is paid every year whether or not claims were high. Whether it is the safest depends on what a bad year would mean for your business.
What is stop-loss coverage?
Insurance an employer buys when it carries part of its own claims risk. It pays when individual or total claims pass an agreed level. Its terms vary widely, which is why we read them closely.
Does a small group have options other than fully insured?
Some do, depending on size, location and claims history. We compare what is realistically available for your group before suggesting anything.
Ready? Upload your renewal, or talk it through with someone first. No cost, no obligation.
General information, not legal advice. Plan-specific questions belong with ERISA counsel, and we will bring them in.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents, two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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