National Benefits News

What should I ask before choosing a self-funded or level-funded plan?

Ask what stop-loss attaches and at what level, how claims and reserves are reported to you, what happens in a bad year, and who is responsible for an overrun. We model these against your group before a recommendation.

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The Answer

Four questions to ask first

Ask what stop-loss attaches and at what level, how claims and reserves are reported to you, what happens in a bad year, and who is responsible for an overrun.

We model these against your group before a recommendation.

In Depth

Questions that expose the risk in a funded plan

Ask what the stop-loss attaches at, whether it covers claims paid or incurred, and whether any individual is excluded or assigned a higher limit. Ask how often you will see claims and reserve reports, and who is responsible for a shortfall.

We build these answers into a model of your group, showing the expected cost and the bad-year cost before we recommend anything.

Related Questions

More questions on this topic

What happened with the Idaho School Benefit Trust?

The Idaho Department of Insurance said the trust told districts on August 20, 2026 of a funding shortfall for the 2025-2026 plan year, which it attributed to higher-than-expected medical and dental claims.

Who pays if a plan’s claims exceed what was collected?

It depends on the plan documents, the funding arrangement and the law that applies.

Is this an example for private employers?

The Idaho trust served public school districts, which are outside our work.

Sources

Where these details come from.

Facts on this page come from these public sources.

Let’s Get to Work

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.

What to send

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.

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