A fully insured plan and a level-funded arrangement allocate cost and risk differently. Neither structure is automatically less expensive; the comparison depends on underwriting, claims, plan terms, and the available market.
Not all level-funded plans are the same. Surplus provisions, network access, stop-loss structures, underwriting, and administrative terms vary. We compare available arrangements against the employer's specific situation and explain the applicable compensation arrangements before engagement.
This page gives you the high-level picture. The real conversation happens when we sit down with your numbers and talk strategy.
How It Works — And Why It Works
Level funding is one structure to evaluate alongside fully insured and self-funded options.
No more mystery pricing
Fully-insured carriers set your premium behind closed doors. Level-funded plans show you exactly what you're paying each month — fixed, predictable, and built on your actual numbers.
You finally see the data
Most employers have no idea where their claims dollars go. With level funding, you get detailed reporting that shows utilization, cost drivers, and where your plan design can improve.
Your downside is capped
The biggest fear with self-funding is a catastrophic claim year. Built-in stop-loss coverage puts a ceiling on your exposure — so one bad year doesn't blow up your budget.
Review how surplus is handled.
Some contracts may provide a surplus refund or credit when claims are lower than funded, while others use different settlement terms or retain amounts for reserves and expenses. Review the contract's calculation, timing, conditions, and renewal treatment.
Renewals based on your story, not theirs
Claims experience may affect a level-funded renewal, along with medical trend, pooling, stop-loss pricing, contract terms, and other underwriting factors. A favorable year does not guarantee a lower renewal.
Your plan, not their menu
Carriers sell you packages. Level funding lets you design deductibles, copays, networks, and pharmacy benefits around what your workforce actually needs — not what's easiest for the carrier to administer.
Where Your Dollar Actually Goes
In a fully-insured plan, your premium disappears into a black box. In a level-funded plan, every component is visible.
Claims Fund
The pool that pays eligible medical claims. Any year-end surplus treatment depends on the contract, reserves, expenses, and settlement provisions.
Stop-Loss Premium
Insurance that caps your exposure. Individual stop-loss protects against any single high-cost claim. Aggregate stop-loss protects against total claims exceeding projections.
Administration
TPA fees for claims processing, network access, member services, and compliance support. Unlike carrier margins, these are transparent and negotiable.
In a fully-insured plan, the carrier bundles all of this together, adds their profit margin, and calls it your "premium." You never see the breakdown — and when claims are low, they keep the difference.
How We Get You There
Transitioning from fully-insured to level-funded isn't complicated — but it does require someone who's done it before.
We look at what you're actually spending
We request your claims experience data from your current carrier, analyze utilization patterns, and identify where your premium dollars are going. If your current broker hasn't shown you this data, that tells you something.
We model the scenarios
Using your actual claims history, we project what a level-funded arrangement would look like — best case, worst case, and expected case. We show you the math, not a sales pitch. If level funding doesn't make sense for your group, we'll tell you and recommend what does.
We design the plan
We work with our TPA partners to build a plan structure around your workforce — networks, deductible tiers, pharmacy benefits, stop-loss thresholds. Every element is tailored, not pulled from a carrier's pre-packaged menu.
We manage the transition
Employee communication, enrollment support, ID card distribution, provider network confirmation. Your employees experience a seamless switch — most don't even notice the funding mechanism changed.
We stay in it with you — all year
Monthly claims reporting. Quarterly trend reviews. Cost containment strategies when utilization spikes. Renewal preparation that starts months before the deadline. This isn't a set-it-and-forget-it arrangement — it's an ongoing partnership.
Is Level Funding Right for You?
It's not for everyone. Here's how to know if it's worth exploring.
Strong candidates
- -Group meets the carrier's current eligibility and underwriting requirements
- -Fully insured for several years with climbing renewals
- -Reasonably healthy employee population
- -Willing to look at claims data and make informed decisions
- -Want predictable costs with upside potential
Might not be the right fit
- -Group does not meet available carrier eligibility or underwriting requirements
- -High-risk population with known large claimants
- -Preference for zero variability in annual costs
- -Not ready to engage with claims data or reporting
Not sure which category you fall into? That's exactly what the initial conversation is for. We'll look at your numbers and give you a straight answer — no pressure either way.
Questions We Hear Most
Level funding raises legitimate questions. Here are the ones every CFO and HR director asks.
We Work With the Best in the Business
Every level-funded carrier has different strengths — network reach, surplus structures, stop-loss terms, plan flexibility. We know the differences because we work across all of them, and we match the right partner to your situation.
These are a few of the carriers and TPAs we work with. The right recommendation depends on your group size, demographics, geography, and goals.
Find Out What You're Overpaying
A 30-minute conversation with our team can show you whether level funding is a fit — and how much you could be saving.