Self-funded vs fully insured calculator: what is the expected cost and the worst case?
Enter expected claims, administration, stop-loss premiums and your fully insured quote to see the expected cost, the maximum cost with aggregate stop-loss and the gap to the insured premium. Built for finance and HR teams weighing a move to self-funding.
Compare self-funding with the insured premium.
Enter per employee per month figures. The result updates as you type.
From your underwriter or claims forecast.
Third-party administrator and network fees.
Covers a single large claim above the deductible.
Covers total claims above the attachment point.
125 percent is common. Use the figure in your quote.
Your current or renewal premium for comparison.
Your comparison
A simple model for planning, not a quote. It leaves out claims run-out, specific claims above the deductible, laser deductibles and the timing of claims. Ask an underwriter to build the real projection.
How does self-funding change the cost?
In a fully insured plan the employer pays a fixed premium and the carrier takes the claims risk. In a self-funded plan the employer pays claims as they happen, plus administration and stop-loss premiums. The employer keeps the money if claims run low and carries the risk if they run high, which is why stop-loss coverage is part of nearly every small and mid-size self-funded plan.
What does stop-loss do?
Specific stop-loss reimburses the plan for a single person’s claims above a deductible. Aggregate stop-loss reimburses the plan when total claims pass an attachment point, often 125 percent of expected claims. Together they put a ceiling on the year. The ceiling is the number to compare with the insured premium, not only the expected cost.
Common questions
Where do expected claims come from?
They come from an underwriter’s forecast built on your claims history, census and plan design. A group with little claims history can lean on the carrier’s manual rates. We help with underwriting and claims forecasting for self- and level-funded plans.
What is level funding?
A level-funded plan is a self-funded plan packaged with fixed monthly payments and stop-loss, and it often returns part of unused claims money after the year ends. Our level-funded page explains the structure.
What does this model leave out?
It leaves out claims that are still being paid after the plan year ends, the effect of individual claims lasers, and the timing of when claims fall. Those can move the real numbers.
Is self-funding right for a small employer?
Sometimes. It depends on the group’s claims, its cash position and how much variation it can absorb. The calculator shows the cost range, and a funding analysis shows the rest.
Talk to us about funding options
Book a 30-minute call and we will review your claims, your stop-loss options and whether a different funding model fits. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
Unhappy With Your Current Broker?
Switching to CFH takes one signed letter. Your carrier, plan, ID cards and payroll deductions stay the same.
Related guides and tools.
Funding Model Analysis
Compare fully insured, level-funded and self-funded options on your own numbers.
Free Employer Benefits Tools
The full set of free calculators for employers.
Second Opinion on Your Renewal
Send us your renewal and we will review it.
Stop-Loss Attachment Point Calculator
See the aggregate attachment point and your deductible in context.
Large Claim Renewal Impact Calculator
See how one large claim could move your renewal.
Pharmacy Rebate Value Calculator
Estimate rebates earned, passed back and kept by the PBM.
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