Self-Funded vs. Level-Funded Health Insurance – Understanding the Differences
Businesses exploring health insurance options often compare self-funded vs. level-funded plans to determine the best fit for their workforce and budget. While both models give employers more control over healthcare costs, they have distinct financial structures and risk levels.
Self-Funded Health Insurance
A self-funded health insurance plan means the employer pays healthcare costs directly rather than paying premiums to an insurance company. This model is common for larger businesses that want greater flexibility and cost savings but are willing to assume higher financial risk.
Key Features of Self-Funded Insurance:
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Employer Controls Costs – Pays for actual healthcare claims instead of fixed premiums.
More Customizable – Businesses can design plans tailored to employee healthcare needs.
Higher Financial Risk – Employers must cover additional expenses if claims exceed expectations.
Exempt from Some Insurance Regulations – Avoids certain state-mandated benefits, offering more flexibility.
Level-Funded Health Insurance
A level-funded plan is a hybrid between self-funding and traditional insurance, offering more predictable costs while still allowing some cost-saving flexibility. Employers pay fixed monthly payments covering expected healthcare claims, administrative costs, and stop-loss insurance to protect against unexpectedly high claims.
Which Plan is Right for Your Business?
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Large corporations with strong cash flow may benefit from self-funded insurance, where long-term savings outweigh financial risks.
Small and mid-sized businesses looking for cost stability and lower risk exposure typically choose level-funded insurance as a compromise.
Both models offer advantages based on company size, financial capacity, and risk tolerance, making it essential for businesses to evaluate their healthcare strategy before choosing a plan.
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