Self-Funded Health Plans in Michigan, Explained Plainly
Many growing employers feel stuck. They pay a high premium every year and never learn where the money went. That frustration is why many owners and HR leaders start asking about self-funded health plans in Bloomfield Hills and across Oakland County.
More guides on this topic.
IBNR and Claims Reserves for Self-Funded Employers.
A self-funded plan owes claims for care that has already happened but has not yet been billed or paid.
Partially Self-Funded and Hybrid Health Plans.
Self-funding does not have to be all or nothing. Many employers fund one part of the plan themselves and insure the rest, or keep their risk low with a high stop-loss cushion.
Administrative Services Only (ASO): What It Is and What You Still Own.
In an ASO arrangement, the employer pays the claims and a carrier or administrator runs the plan: the network, claims processing and member service.
We are an independent employee benefits consulting firm, in business since 2007. We help you decide whether self-funding fits your company. If it does, we find, set up and oversee the partners who run it. Compare the expected and worst-case cost with our self-funded vs fully insured calculator.
Self-Funded Health Plans
In a self-funded plan, the employer pays employee medical claims as they happen, instead of paying a fixed premium to a carrier. The technical term is “self-insured.” A third-party administrator, or TPA, processes the claims. Stop-loss insurance protects you from very large claims or a bad year. Our free stop-loss attachment point calculator shows where aggregate protection begins next to expected claims.
CFH is not a TPA. Our job is to help you pick the structure, compare administrators and stop-loss carriers, and hold the administrator to its contract. We review the claims reports with you and explain what they mean in plain words. Our free pharmacy rebate value calculator estimates how much of the rebates a plan could receive.
Self-funding lets you see your own claims data. You can shape the plan design. You may keep money that is not spent in a good year. But your costs can swing more from year to year. It is not the right fit for every company. For a quick estimate, use our free PMPM claims calculator.
Self-funded plans also carry federal ERISA duties, such as plan documents, notices and filings. We help keep you ERISA compliant. Form 5500 and the PCORI fee are due by July 31 for calendar-year plans that must file.
Is my company big enough to self-fund?
There is no single cutoff. In Michigan, a group of 50 or fewer employees is small group, and rates come from carrier filings, ages and ZIP codes. Above 50, your own claims start to count. That is the range where many employers begin to look at self-funding. Smaller groups often look at level-funded plans first, which are a gentler step.
Ask yourself a few questions. Can your cash flow handle a month with high claims? Is your workforce fairly steady? Do you want to see your data and act on it? If the answers are yes, self-funding deserves a closer look.
What is the difference between self-funded and fully insured?
With a fully insured plan, you pay a set premium and the carrier takes the risk. You get little data back. With a self-funded plan, you pay claims, buy stop-loss protection and get your data. A level-funded plan sits in between the two.
Self-funded vs fully insured for 80 employees
At 80 employees you are in the large group market, the ACA employer mandate applies, and your own claims experience starts to count in how the carrier prices you. Fully insured is still the default at this size, and it is the right answer for many groups. What changes is that you have real alternatives: a level-funded plan is realistic, while full self-funding is usually a stretch until you have roughly 100 enrolled employees with steady claims. The number that matters is enrolled employees, not headcount, because a group of 80 where 55 enroll is priced and underwritten as a group of 55.
To compare the options for your own group, put three things side by side: the fully insured renewal, a level-funded quote, and the expected claims behind each. Look at what you gain (your claims data, and a possible refund if claims run low) against what you take on (claims above expected and the cash flow to carry them). Read the stop-loss terms closely, including any lasered conditions that leave a known risk uncovered. A group of 80 may sit under the 100-participant line for Form 5500, depending on enrollment, but the summary plan description requirement applies either way. Send us your renewal and we will model all three side by side, and see what changes at fifty employees if you are close to that line.
Everything a self-funded plan is made of
A self-funded plan is not one contract. It is a set of vendors and documents that you, as plan sponsor, put together and oversee. Knowing each part is the fastest way to judge a proposal.
The Plan Sponsor
That is your company. You are the plan administrator and a fiduciary under ERISA, which means you are responsible for running the plan prudently, even though vendors do the daily work. In practice that means someone inside the company must own decisions, approve vendors, and make sure the plan is operated as written. Many sponsors rely on advisers and counsel to support that role.
The Plan Document And SPD
The written rules of the plan: eligibility, benefits, exclusions, appeals. A self-funded plan needs its own plan document and summary plan description. A carrier booklet does not replace them. Sponsors should confirm who drafts it, who keeps it current when the plan changes, and where employees can find the latest version. Gaps here often surface only after a disputed claim, so review it before launch.
The Third-Party Administrator
The TPA processes claims, issues ID cards, answers member calls and produces reports. It does not take the claims risk. See our guide to choosing a TPA.
The Provider Network
Most self-funded plans rent a network, which sets the discounts you pay. Network choice drives both cost and which doctors your employees can use. Compare how each network performs in the areas where your employees actually live and work, and ask for a disruption report showing which current providers would be in or out before you commit.
The Pharmacy Benefit Manager
The PBM manages the formulary, pharmacy network, rebates and specialty drugs. Pharmacy is often the fastest-growing part of the claims bill, so how the PBM is paid matters. Ask how the PBM is compensated, whether rebates are passed through, and how specialty drugs are handled. Understanding those terms early helps you judge whether the pharmacy arrangement truly supports your plan goals.
The Stop-Loss Carrier
The insurer that reimburses the plan when one claim or total claims pass the limits you chose. It is the safety net that makes self-funding workable for mid-size employers. Policies differ on what they cover, how claims are measured and when they must be filed, so read the contract terms closely and ask your adviser to walk through how a large claim would actually be reimbursed.
The Claims Funding Account
Money moves from your bank account to pay claims as they are processed, often through a dedicated account the TPA draws on. How and how often you fund it shapes your cash flow. Ask how claims are funded, how quickly the TPA expects money, and what reserve you want on hand, so a heavy claims month does not catch finance off guard.
Your Broker And Consultant
We help select the vendors, negotiate fees, check the contracts and watch the numbers through the year. We never administer the plan ourselves. Our role is advisory. We help you compare options and understand the tradeoffs, while the plan sponsor and its chosen vendors carry out the day-to-day work and make the final decisions.
The stop-loss contract decides how much risk you really carry
Two stop-loss quotes with the same premium can leave very different exposure. These are the terms that matter most. For the basics, see what stop-loss insurance is.
Specific Deductible
The amount a single person’s claims must reach before stop-loss pays. Lower deductibles cost more in premium and protect more. Higher deductibles cost less and put more of the risk on you. Many employers revisit this number each year as claims experience and budget comfort change. Model a few deductible levels against what your finance team could absorb in a bad year before choosing.
Aggregate Attachment Point
The total-claims level at which aggregate stop-loss starts to pay, usually set as a percentage of expected claims. It protects against a bad year caused by many mid-size claims instead of one large one. Ask how the attachment point is calculated, whether it is fixed or tied to enrollment, and how it moves if headcount changes during the year, since that can change how much protection you really have.
Contract Basis
Stop-loss covers claims incurred and paid within stated windows, such as twelve months incurred and fifteen months paid. Shorter windows leave a gap for late claims, and a longer paid window narrows it. Matching the contract basis to your TPA run-out practices matters, because a mismatch can leave claims uncovered. Have your adviser compare the basis across quotes rather than looking only at premium.
Lasering
The carrier may set a higher deductible for a specific person with known high costs. Ask for every laser by name and amount, and ask whether lasers can be added or raised at renewal. Lasers can change the real cost of a quote, so compare proposals with the same assumptions. A low premium that includes several large lasers may protect you less than it first appears.
No New Lasers
Some contracts promise not to add new lasers at renewal. That protects you after someone develops a serious condition, and it is worth asking about for a multi-year commitment. Get any such promise in writing within the contract itself, and confirm the exact wording and any exceptions, since a verbal assurance or a marketing summary will not control if a dispute arises.
Reimbursement And Notice
Stop-loss pays the plan back after the plan has paid the claim, and it requires timely notice of large claims. Missed notice can cost coverage, which is why claims and stop-loss reporting is a real task.
Exclusions And Eligibility
Read what the contract does not cover and who must be actively at work to be covered. Mismatches between the plan document and the stop-loss policy are a common source of denied claims. Compare the stop-loss policy side by side with the plan document before you sign, and have counsel or your adviser flag any difference in definitions, since a gap between the two is where disputed claims tend to start.
Renewal And Rate Caps
Ask how stop-loss is rated at renewal, whether a cap or guarantee is offered and what it costs. Our guide on stop-loss negotiation covers what is negotiable.
How to budget a plan whose cost moves with claims
The most common worry is not the average year. It is the bad one. A budget built in three layers answers that worry.
Fixed Costs
Administration, network access, pharmacy fees and stop-loss premium are known in advance. They are the part of the budget that behaves like insurance. Because these costs do not rise and fall with claims, they are the easiest to negotiate and compare across vendors. Ask each vendor to list every fee separately so nothing hides inside a bundled rate.
Expected Claims
The projected claims for the year. They are an estimate built from your census and any claims history, and they set the target your actual claims are compared against. Ask how the estimate was built, which assumptions drive it, and how much weight the vendor gave to your own experience, because a thin claims history can make this projection less reliable than it looks.
Maximum Exposure
Fixed costs plus the aggregate attachment point give a ceiling on what the plan should cost for the year. A proposal should show this number clearly. It is the figure to take to your CFO. Ask for it on one page, with the assumptions listed, so leadership can see the worst reasonable year alongside the expected one before approving the move.
Monthly Claims Fluctuation
Claims are lumpy. One month can run well above average and the next well below. Budget for the year, and track the running total against expected claims each month. A simple monthly report comparing actual to expected claims helps finance spot a trend early and avoid surprises. Ask your TPA what reporting is included and how quickly after month-end it arrives.
Funding And Cash Flow
Claims may be funded weekly, every two weeks or monthly. A funding schedule that matches how claims are paid avoids large single drafts on your account. Work with your finance team and TPA to choose a rhythm that fits your payroll and bank balances, and ask what notice you get before a draft so cash is available when it is needed.
Reserves And Unpaid Claims
At year-end some claims have been incurred but not yet paid. Your accountant needs an estimate of that liability for the books, and your TPA can help supply it. Ask your auditor or tax adviser how they want this liability reported, and agree on the timing of the estimate in advance so year-end close does not stall waiting for claims data.
What Happens To A Surplus
If claims run below expected, the savings stay with you. That is the central difference from a fully insured plan, where unused premium belongs to the carrier. The reverse also applies. If claims run high, you pay the difference up to the stop-loss limits, so set aside funds and decide in advance how any surplus will be used or held.
Reporting To Leadership
Quarterly summaries of claims against expected, large claimants and pharmacy trends keep finance and HR working from the same numbers. Agree on the format and calendar up front, and ask that large claimants be shown in a way that respects member privacy, so leadership gets the full picture without seeing protected details.
How to evaluate a TPA, a network and a pharmacy manager
Vendor choice affects member experience as much as cost. These are the questions we bring to the table.
Claims Accuracy And Speed
Ask for processing turnaround and payment accuracy measures, and how errors are found and corrected. Michigan has rules on timely payment, covered in our prompt pay guide.
Network And Balance Billing
Check discounts, access in your areas and what protection members have when a provider bills above the allowed amount. Ask how out-of-network claims are priced and how the vendor handles member complaints about unexpected bills. Employees notice these problems first, so understanding the process helps HR respond with confidence.
Reporting And Data Access
You should be able to see claims detail, large claimants and pharmacy spend. Ask who owns the data and whether you keep it if you leave. Put data ownership, file formats and exit terms in the contract before you sign. Access to your own claims history also helps when you go back out to market or evaluate stop-loss renewals.
Stop-Loss Coordination
A TPA should report large claims to the stop-loss carrier promptly and in the form the contract requires. Ask how that works day to day. Ask for sample notices and the typical turnaround, and confirm who is responsible if a deadline is missed. Reimbursement can depend on timely reporting, so this process deserves a clear owner.
Fee Transparency
Fees should be itemized. Look for per-claim fees, network access fees, case management fees and anything billed outside the base administration charge. Request a complete fee schedule in writing and compare it line by line across proposals. Small charges add up, so ask which fees apply per member, per claim or per transaction and how they change.
Member Service
Employees judge the plan by the call they make on a bad day. Ask about hold times, hours, and whether there is help resolving a claim problem. Ask references how problems were handled, and check whether a dedicated contact is assigned to your group. Strong service reduces the escalations that land on HR and keeps small claim problems from becoming morale issues.
Pharmacy Model
Understand whether the PBM keeps a spread, passes through the price it pays, or returns rebates, and how those are shown to you. Pharmacy compensation should be disclosed. Ask for a sample pharmacy report showing what the plan paid and what the PBM kept, if anything. Clear disclosure makes it easier to compare PBM proposals on equal terms and to challenge charges that look unusual.
Compliance Support
Ask which compliance filings the vendor prepares and which stay with you. Our transparency in coverage guide shows how responsibilities are usually split.
The levers that control claims once you self-fund
Self-funding gives you data and choices that a fully insured plan does not. These are the levers, and which ones suit you depends on your group.
Network Strategy
A broad, narrow or tiered network changes cost and access. We match the network to where your employees live and which providers they use. Ask each vendor to run a disruption analysis against your employees’ current providers. Cost matters, but a network that sends many employees to unfamiliar doctors can create friction that outweighs the discount.
Pharmacy Management
Formulary design, specialty drug programs and rebate terms often decide pharmacy cost more than discounts do. Ask how specialty drugs are managed, what clinical programs are included, and how rebates are shared with the plan. These terms deserve as much attention as the headline discount percentage in the proposal.
Case And Utilization Management
Nurse case management and review of high-cost care help steer people to the right setting. See our guide to managing high-cost claimants.
Reference-Based Pricing
Paying providers by a benchmark price instead of a network discount can reduce cost, and it can create balance billing problems. We advise on it case by case. See reference-based pricing.
Direct Primary Care
Pairing the plan with direct primary care can lower downstream cost for some groups, and it needs a clear fit with your workforce. Results vary with how many employees live near a clinic and whether they use it, so test the idea against your own workforce and ask for the arrangement’s terms and exit options before committing.
Group Captives
Some employers share stop-loss risk with other employers through a captive. It adds control and obligations, and it is a bigger commitment. See group captives and captive evaluation.
Plan Design
Deductibles, copays, tiering and eligibility all change claims. A mid-year design change is usually harder than a design built into the plan document at renewal. Test any proposed change against your own claims and workforce before adopting it, and consider how employees will react. Design choices that look efficient on paper can drive confusion or delayed care if they are poorly explained.
Data Review
Regular claims review shows what is driving cost and which changes are working. The data is the real prize of self-funding. Ask your TPA how often data is refreshed and whether you can analyze it yourself or through your adviser. Review it on a set schedule so findings turn into decisions instead of sitting in a report.
What can go wrong, and how to guard against it
Self-funding rewards preparation. The failures we see come from a short list.
A Bad Claims Year
Stop-loss limits the damage, and the retained risk is still real. Know the maximum number before you start and have a plan to cover it. Share that figure with finance and leadership ahead of time, and consider holding a reserve. Having the conversation before a large claim arrives is far easier than explaining a shortfall afterward.
Stop-Loss Denials
A claim can be denied for late notice, an exclusion or a mismatch with the plan document. Align the two documents before the year begins. Keep notice procedures simple and assign someone to track deadlines. Ask your adviser or counsel to review both documents together each year, particularly after any plan amendment or change in vendors.
Lasers At Renewal
A person with a major condition can be lasered at renewal, shifting more cost to you. Ask for no new lasers if you can get it. Whether this is available varies by market and by the overall deal, and it may affect the premium. Discuss the tradeoff with your adviser rather than assuming it can simply be added to the quote.
Vendor Errors
A TPA can pay a claim wrongly or miss a stop-loss notice. Audit rights and regular reviews catch problems early. Build audit rights into the TPA contract, schedule periodic claim samples, and ask for corrective steps in writing when errors surface. A habit of review is usually cheaper than discovering a pattern of mistakes years later.
Fiduciary Exposure
As plan sponsor you are responsible for prudent selection and monitoring of vendors. Keep a record of how you chose them and what you reviewed. Counsel can advise on what a prudent process looks like for your organization. Consider documenting meeting notes, comparison materials and the reasons behind each decision so your file shows how the choices were made.
Compliance Gaps
Missed filings carry penalties, and the TPA does not file everything for you. See the compliance band below and our compliance calendar.
Member Dissatisfaction
A change of network or pharmacy can disrupt care. Communication and transition support limit the damage. Plan notices well ahead of enrollment, share provider and drug lookup tools, and tell employees how to request transition help. Early, clear communication usually prevents a surge of frustrated calls to HR.
Difficult Exit
Leaving a self-funded plan raises questions about runout claims and stop-loss terminal liability. Plan the exit terms when you sign. Ask now about run-out periods, how long the TPA will keep paying claims after termination, and what the stop-loss carrier requires. Settling these points at signing leaves you more leverage than raising them later.
What a self-funded plan sponsor has to do
Self-funded plans are governed mainly by federal law, and the employer carries duties that a carrier carries in a fully insured plan.
ERISA Fiduciary Duties
Run the plan for the benefit of participants, follow the plan document, choose and monitor vendors prudently, and keep records. See ERISA preemption for why state insurance law mostly does not apply.
Plan Document And SPD
Required, and a carrier booklet is not a substitute. Read SPD versus benefits guide.
Form 5500
Plans with 100 or more participants file annually. Smaller self-funded plans are often exempt when benefits are paid from general assets, but the arrangement matters, so confirm it.
PCORI Fee And ACA Reporting
The plan sponsor pays the PCORI fee directly, and applicable large employers file Forms 1094-C and 1095-C, including the covered-individual reporting for self-funded plans.
Transparency And Consolidated Appropriations Act Duties
Machine-readable files, prescription drug data reporting, gag clause attestations, mental health parity comparative analyses and compensation disclosures. Roles are assigned by contract, so get them in writing. Ask your TPA and counsel which tasks each will handle, and keep a calendar with an internal owner for each item. Requirements change, so confirm current rules with your legal adviser rather than relying on a vendor summary.
HIPAA Privacy
A self-funded plan is a covered entity. That means business associate agreements with the TPA and other vendors, and rules on who inside your company can see claims information. See email, text and HIPAA.
Nondiscrimination Testing
Self-insured plans can face tax-code nondiscrimination rules that insured plans do not. See our testing guide.
COBRA And Other Notices
The plan still owes COBRA, marketplace and other required notices. The TPA may issue some of them, and the employer stays responsible. Confirm in the TPA agreement which notices are issued on your behalf, how quickly they go out, and how you will check that they did. Late or missing notices can create problems that counsel should assess.
General information, not legal advice. Plan-specific questions belong with ERISA counsel, and we will bring them in.
What the first year of a self-funded plan looks like
Moving to self-funding is a project, and the schedule works backward from your effective date.
Several Months Before
Feasibility review, claims analysis and a first look at expected cost against your insured renewal. This is when we decide whether to proceed at all. Gather census data, current plan documents and recent claims reports early, since gaps in data slow every later step. A realistic look at cash flow and risk tolerance belongs here too.
Marketing
TPA, network, pharmacy and stop-loss proposals are gathered and compared on fees, terms and service. Underwriting for stop-loss begins here. Give every bidder the same data and the same questions so proposals can be compared fairly. Look beyond price to contract language, service model and how each piece works with the others.
Contracting
Final stop-loss terms, TPA agreement, business associate agreements, plan document and SPD. This is when mismatches between documents are fixed. Have counsel review the documents together before signing. Check that definitions, eligibility rules and exclusions line up across them, and make sure each party’s responsibilities are written down clearly.
Implementation
Eligibility feeds, ID cards, funding accounts, communication to employees and a test of claims flow before the effective date. Set a testing plan and a named owner for each task. Late file errors or missing funding steps can delay claims or ID cards, which employees notice immediately, so leave time to correct them.
The First Quarter
Early claims are watched closely. Errors in claim setup show up fast and are cheaper to fix early. Ask the TPA for early reports, review a sample of paid claims, and gather employee feedback on service. Catching setup issues in the first months keeps small mistakes from becoming repeated ones.
Quarterly Reviews
Claims against expected, large claimants, pharmacy trends and any stop-loss notices. We bring these to your leadership. Set the meeting calendar at launch so reviews happen even when everyone is busy. Consistent review gives leadership early notice if experience is moving away from expectations and allows time for adjustments.
Renewal
Stop-loss and vendor terms are re-underwritten on the year’s experience. We start the renewal well ahead of the effective date. Renewal outcomes depend on claims, large claimants and market conditions, so gather data early and prepare questions for the stop-loss carrier and TPA. Ask what changes are possible before final terms are due.
Year Two And After
The goal is a plan you understand and control, with a long view on cost. We follow our DATUM process each year.
Signs you may be ready, and signs to wait
Self-funding fits some groups well and others poorly. A candid look at your situation matters more than the size of your payroll.
Signs You May Be Ready
Stable finances and cash flow, leadership comfortable with variation in monthly cost, steady headcount, an interest in claims data, and a fully insured renewal that does not reflect your own experience. No single sign decides the question, so weigh them together with your adviser and finance team, and revisit the answer as your business and risk tolerance change.
Signs To Wait
Thin cash reserves, a workforce that changes sharply during the year, leadership that cannot accept a bad month, or no one at the company who can oversee the plan. Waiting is a reasonable choice, not a failure. You can revisit the idea later, and some employers use the time to strengthen reserves and oversight first.
A Middle Path
Level-funding offers a fixed payment with a refund, which many employers use as a first step. See level-funded health plans.
See The Numbers
Our funding comparison calculator and funding options guide compare the paths on your own figures.
Common questions
Can a company with 80 employees self-fund?
Legally yes, because there is no minimum size, but it is usually not the practical first step. At 80 employees most groups look at a level-funded plan first, which caps the monthly swing while giving you claims data. Full self-funding is generally practical at roughly 100 enrolled employees with steady claims, a cash reserve for a bad month, and stop-loss terms you have read closely.
How many employees do you need to self-fund health insurance?
There is no legal minimum. In practice, self-funding tends to make sense from around 100 enrolled employees, and level-funded plans fill the gap for smaller groups. The deciding factors are steady claims, cash flow to absorb a high-claims month, and whether you want your claims data and the control that comes with it.
Do employees lose their doctors if we self-fund?
Not always. Many self-funded plans use a carrier’s network, so employees can often keep the same doctors. We check this with you before you decide. The check covers the doctors and hospitals your people use most, and anyone mid-treatment or expecting a baby, since those are the cases where a network difference matters right away. If a narrower network is part of the savings, you see that before you sign.
Who helps employees with claim problems?
The administrator processes claims. Our customer service team helps employees when something goes wrong and presses the administrator for an answer. That includes finding out whether a denial was a plan decision or a processing error, and when a plan decision is disputed, making sure the appeal reaches the plan with the right record attached.
Can we go back to a fully insured plan?
Usually, yes, at a renewal. We plan the exit with you, including how late claims will be paid. The run-out matters because claims incurred before the switch keep arriving for months and are paid by the self-funded plan, not the new carrier. Stop-loss terms matter here too, since some policies stop covering claims paid after the contract ends.
What is the most we could pay in a year?
Your fixed costs plus the aggregate attachment point, with the specific deductible capping any one person. The proposal should state that number plainly. If it does not, ask for it.
Who is responsible if the TPA makes a mistake?
You are, as plan sponsor, though the TPA is liable to you under its contract. That is why audit rights, performance standards and regular reviews matter.
How is self-funding different from a captive?
In a captive, several employers share some of their stop-loss risk. It is a way to self-fund with added risk sharing and added obligations. We place group captives and can compare them to a standalone plan.
How long does it take to set up?
Plan on a project that starts several months before the effective date. Marketing stop-loss, contracting and implementing take time, and a rushed start tends to produce errors.
What data will we get?
Claims detail, large claimant reports, pharmacy spend and utilization, subject to HIPAA limits on who at the company may see what. Confirm what the TPA provides and who owns it.
Is self-funding allowed in Michigan?
Yes. Employers may self-fund under federal law, and ERISA keeps most state insurance rules from applying to the plan. The stop-loss policy is still an insurance contract and is regulated as one.
What is a stop-loss deductible, and how do we choose one?
It is the amount any one person’s claims must reach before stop-loss starts to pay. A lower deductible costs more in premium and carries less risk. A higher one costs less and puts more on you. We model several deductibles against your cash reserves and claims history, then you choose how much risk to keep.
Can we self-fund a plan for employees in several states?
Generally yes. A self-funded plan is governed by one federal framework, which helps when employees work in different states. Network access in each state still matters, and some state rules can still reach the plan, so we review each location.
Do we have to offer the same plan to everyone?
Not always, but self-insured plans can face tax-code nondiscrimination rules on eligibility and benefits. A design that favors highly compensated employees can create problems, so we review the plan before it launches. See our testing guide.
What should we do first if we are curious about self-funding?
Send us your renewal, your census and claims experience if you have it. We compare the insured renewal with self-funded and level-funded options and show the downside next to the upside. Send us your renewal. There is no cost and no obligation.
Talk to us about self-funded health plans in Michigan
Send us your renewal or book a 30-minute call. We will tell you honestly whether self-funding makes sense for you. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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Related reading: Employer-Funded PBMs: ScriptGuideRX and More · Section 105(h) Nondiscrimination for Self-Insured Health Plans · PCORI Fee for Employer Health Plans · RxDC Prescription Drug Reporting for Employer Plans · Gag Clause Prohibition and the Annual Attestation · Blue Cross Blue Shield of Michigan Group Health Insurance · Fully Insured Group Health Insurance · Group Health Insurance Hub
Related guides.
Manufacturing Employers
Shift workers, plant claims, funding choices and union coordination.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
ERISA (29 U.S.C. Chapter 18)
The federal law that sets reporting, disclosure and fiduciary rules for employer-sponsored benefit plans.
COBRA Continuation Coverage (29 U.S.C. 1161)
Requires many group health plans to offer temporary continuation coverage after a qualifying event.
Affordable Care Act (Public Law 111-148)
The 2010 health reform law, with later amendments, behind employer coverage, reporting and market rules.
ACA Reporting (26 U.S.C. 6056)
The statute behind employer reporting of offers of coverage on Forms 1094-C and 1095-C.
HIPAA Privacy Rule (45 CFR Part 164)
Federal privacy and security standards for protected health information held by health plans.
Plan Reporting (29 CFR Part 2520)
The Department of Labor rules for annual plan reports, including Form 5500.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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