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Level-Funded vs. Self-Funded: A Practical Guide to Comparing Options

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Level-Funded vs. Self-Funded: A Practical Guide to Comparing Options

Quick Overview: Level-Funded vs. Self-Funded Health Plans

  • Level-Funded: Employers pay a fixed monthly amount. The financial risk is shared with a stop-loss insurer. Costs are more predictable, and there may be rebates if claims are lower than expected.
  • Self-Funded: Employers pay for health claims as they occur, leading to potentially unpredictable costs. The employer bears the full financial risk, but may save money if claims are lower than expected.

Choosing between level-funded and self-funded health insurance plans can feel like navigating a maze without a map. If you’re a small to medium-sized business owner, the decision affects not just your finances, but the well-being and retention of your employees. With health insurance being a top priority for many workers, it’s crucial to get this choice right.

The health insurance landscape is vast and can be confusing. Level-funded plans are somewhat of a middle ground, offering more predictability in costs than self-funded plans, but with some of the cost-saving and customization advantages that self-funded plans provide. Self-funded plans, on the other hand, give employers complete control over their plans, which can be great for saving money but come with higher risk if claims exceed expectations.

Infographic detailing the main differences between Level-Funded and Self-Funded health plans, including a comparison of funding models, risk responsibility, cost management, and savings potential. - level funded vs self funded infographic comparison-2-items-casual

Making an informed decision requires understanding these options inside out, assessing your business’s specific needs, and considering the financial health of your company. Let’s dive deeper into what these funding models entail and how they can impact your business and your employees.

Understanding Health Insurance Funding Models

When it comes to choosing health insurance for your business, the options can feel like a maze. But don’t worry, we’re here to light the way. Let’s break down the three main types of health insurance funding models: Self-Funded, Level-Funded, and Fully-Insured.

Self-Funded Plans

Imagine you’re at a casino, but instead of gambling with chips, you’re betting on your employees’ health costs. That’s the self-funded model in a nutshell. You, the employer, pay for your employees’ health claims directly. If your employees are healthy and don’t make many claims, you could save a lot of money. But if someone hits a health snag, you might end up paying more.

  • Risk: High. Like a rollercoaster, it can be unpredictable.
  • Cost Management: Tricky. Big health claims could throw off your budget.
  • Savings Potential: High. If your employees are healthy, you keep the savings.

Level-Funded Plans

Now, imagine you’re wearing training wheels while gambling. That’s a level-funded plan. You pay a fixed monthly amount, part of which goes into a reserve for health claims. If your employees’ claims are lower than expected, you might get a refund at the end of the year. It’s like self-funding but with a safety net.

  • Risk: Moderate. You have a safety net in the form of stop-loss insurance.
  • Cost Management: Predictable. You know your costs upfront.
  • Savings Potential: Moderate. You might get a refund if claims are low.

Fully-Insured Plans

Finally, picture yourself handing your money over to a casino and letting them handle everything. That’s a fully-insured plan. You pay a fixed premium to an insurance company, and they take care of all the health claims. It’s simple and straightforward, but it might cost more, especially if your employees are healthier than average.

  • Risk: Low. The insurance company takes on the risk.
  • Cost Management: Fixed. You know exactly what you’re paying each month.
  • Savings Potential: Low. You won’t save if your employees have fewer claims.

So, Which to Choose?

  • If you like control and are willing to take on risk for potential savings, self-funded might be your path.
  • If you want a bit of both worlds – control and predictabilitylevel-funded could be the way to go.
  • If you prefer to avoid risk and like simplicity, fully-insured plans could be your best bet.

Each business is unique, and the right choice depends on your appetite for risk, your financial health, and how much control you want over your health benefits. NPA Benefits can help guide you through these options, ensuring you make the best decision for your company and your employees.

In the next sections, we’ll delve deeper into the advantages and disadvantages of each model, helping you further understand which option aligns best with your business goals.

Key Differences Between Level-Funded and Self-Funded Plans

When exploring health insurance options, understanding the key differences between level-funded and self-funded plans is crucial. These differences can significantly impact your business’s financial health, risk management, and the overall benefits you can offer to your employees. Let’s break down these differences into four main areas: Funding Model, Risk Responsibility, Cost Management, and Savings Potential.

Funding Model

  • Self-Funded Plans: In a self-funded model, your business pays for employee healthcare claims directly as they occur. This pay-as-you-go approach means your costs each month can vary based on the healthcare usage of your employees.

  • Level-Funded Plans: Level-funded plans combine elements of self-funding with the predictability of a fully insured plan. Your business pays a fixed monthly amount. This amount covers estimated claims, stop-loss insurance, and administrative fees. If claims are lower than expected, your business may receive a rebate or credit.

Risk Responsibility

  • Self-Funded Plans: Your business assumes the full risk of covering healthcare costs. This means if claims are higher than anticipated, your business is responsible for covering these costs, which can impact financial planning.

  • Level-Funded Plans: Risk is shared with a stop-loss insurer. This means if healthcare claims exceed a certain threshold, the stop-loss insurance will cover the excess costs, providing a safety net for your business.

Cost Management

  • Self-Funded Plans: Costs can be unpredictable, making budgeting challenging. A single high-cost claim can significantly impact your finances. However, you also have the potential for savings if claims are lower than expected.

  • Level-Funded Plans: Costs are more predictable, thanks to the fixed monthly payments. While you still benefit from lower claims through potential rebates or credits, the predictability can make financial planning easier.

Savings Potential

  • Self-Funded Plans: There’s a higher potential for savings if your employees have fewer healthcare claims than anticipated. You directly benefit from lower healthcare usage, as you’re paying for claims as they occur.

  • Level-Funded Plans: Savings potential is more structured. If claims are lower than the funds allocated for them, your business may receive a rebate or credit at the end of the plan year. However, this “refund” is often only a portion of the actual savings.

In summary, self-funded plans offer more control and potentially higher savings but come with greater risk and unpredictability. Level-funded plans provide a middle ground with more predictable costs and shared risk, making them an attractive option for businesses looking for stability in their healthcare spending.

NPA Benefits can assist in navigating these options, ensuring your business finds the right balance between cost, risk, and benefits provided to your employees. Understanding these key differences is the first step in making an informed decision that aligns with your business goals and needs.

Advantages and Disadvantages of Level-Funded Plans

When it comes to choosing between level funded vs self funded health insurance plans, understanding the pros and cons of each can significantly impact your decision. Let’s dive into the advantages and disadvantages of level-funded plans to give you a clearer picture.

Advantages of Level Funding

  • Predictable Monthly Costs: With level-funded plans, businesses enjoy the consistency of fixed monthly payments. This predictability helps in budgeting and financial planning throughout the year.

  • Lower Monthly Costs: Compared to traditional fully insured plans, level funding can offer lower monthly costs because you’re essentially paying for your own claims up to a certain stop-loss limit.

  • Customization: One of the standout features of level-funded plans is the ability to tailor benefits to meet the specific needs of your employees, offering a competitive edge in attracting and retaining talent.

  • Unused Claim Funding: If your claims are lower than expected, you may receive a rebate or credit towards the next policy year, which can result in significant savings.

  • Claims Data Access: Having access to your claims data enables you to identify trends, manage costs more effectively, and implement wellness programs that address the specific health needs of your workforce.

  • Premium Taxes Reduction: Level-funded plans are often subject to fewer state taxes and regulations, leading to additional savings on premium taxes.

Disadvantages of Level Funding

  • Claims Exceeding Coverage: If claims unexpectedly exceed the stop-loss coverage, it could result in financial strain, although this risk is mitigated by the stop-loss insurance.

  • Plan Administration: While less burdensome than self-funded plans, level-funded plans still require some degree of administrative effort from the employer to manage the plan effectively.

  • Compliance Challenges: Navigating the regulatory environment can be more complex with level-funded plans compared to fully insured plans, requiring a good understanding of both federal and state laws.

  • Integrated Wellness Programs: While access to claims data can aid in the creation of wellness programs, effectively integrating these into the level-funded plan to reduce costs and improve employee health can be challenging.

In conclusion, level-funded plans offer a middle ground between the predictability of fully insured plans and the cost-saving potential of self-funded plans. For businesses looking for more control over their healthcare expenses without the full financial risk of self-funding, level funding presents a viable option. NPA Benefits is here to help you weigh these factors and choose the plan that best fits your business needs and objectives. Moving forward, let’s explore how to decide which plan is right for your business, considering factors such as business size, healthcare costs, and desired level of flexibility and control.

Advantages and Disadvantages of Self-Funded Plans

When it comes to choosing between level funded vs self funded health insurance plans, it’s crucial to weigh the pros and cons. Self-funded plans offer distinct advantages but also come with their own set of challenges.

Advantages of Self-Funding

Control Over Plan Design: One of the biggest perks of self-funding is the ability to customize your health plan. You get to decide what your plan covers, tailoring it to the specific needs of your employees. This means you can include benefits that are most valued by your team, enhancing employee satisfaction.

Surplus Funds Retention: If your claims are lower than expected, your business gets to keep the difference. This can lead to significant cost savings, especially in years when healthcare usage is minimal. It’s like having a health plan that can also act as a savings account.

Direct Payment for Healthcare: With self-funding, you pay for healthcare costs directly. This eliminates the middleman and can reduce administrative costs. It also gives you a clearer picture of where your healthcare dollars are going.

Regulatory Freedom: Self-funded plans are governed by the Employee Retirement Income Security Act (ERISA), which preempts state insurance laws. This means less red tape and potentially fewer costs related to state mandates.

Disadvantages of Self-Funding

Unpredictable Costs: The flip side of potential savings is the risk of unpredictable costs. If your employees have a year with high healthcare usage, your costs could skyrocket. This unpredictability makes budgeting for healthcare expenses more challenging.

Catastrophic Claims Risk: A single catastrophic claim can have a significant financial impact on your business. While stop-loss insurance can mitigate this risk, it’s an additional cost and doesn’t eliminate the risk entirely.

Administrative Burden: Managing a self-funded plan requires more administrative work. You’ll need to handle claims processing, plan design, and compliance with federal regulations. This can be a significant burden, especially for smaller businesses without a dedicated HR department.

Lack of Stop-Loss Insurance: While not inherent to all self-funded plans, some businesses may opt not to purchase stop-loss insurance to save on costs. This decision can expose them to significant financial risk if large or numerous claims occur.

In summary, self-funded plans offer a high degree of control and potential cost savings but come with financial risks and administrative burdens. It’s important to carefully consider these factors and consult with experts like NPA Benefits to determine if self-funding is the right choice for your business. Moving forward, we’ll delve into frequently asked questions about level-funded and self-funded plans to help you make an informed decision.

How to Decide Which Plan is Right for Your Business

Choosing between level-funded and self-funded health insurance plans is a big decision for any business. Let’s break it down into simple terms to help you make the best choice for your company. We’ll look at business size, healthcare costs, flexibility and control, regulatory environment, and the role NPA Benefits can play in your decision-making process.

Business Size

  • Small to Mid-sized Businesses: If your business has a relatively small number of employees, a level-funded plan might be more suitable. These plans offer the benefits of self-funding but with less risk and more predictability in costs. They’re designed to be accessible for smaller companies.

  • Large Businesses: Larger businesses with more employees might find self-funded plans more appealing. The larger pool of employees can make it easier to predict healthcare costs, and the potential savings from paying for healthcare directly can be significant.

Healthcare Costs

  • Predicting Costs: If your business prefers predictable healthcare costs, level-funded plans offer a more stable option. You pay a fixed monthly amount, which can help with budgeting.

  • Potential Savings: If your business is willing to take on more risk for the possibility of saving money, self-funded plans could be the way to go. You might pay less if your employees have fewer health claims than expected.

Flexibility and Control

  • Customization: Self-funded plans offer more flexibility in terms of plan design. You can tailor the benefits to meet the specific needs of your employees. Level-funded plans offer some customization, but it’s generally more limited.

  • Control Over Costs: Self-funded plans give businesses more control over healthcare costs. You can directly influence costs by implementing wellness programs or negotiating prices for services.

Regulatory Environment

  • Compliance: Self-funded plans are subject to federal regulation under ERISA but are exempt from state insurance regulations. This can mean fewer taxes and regulatory costs. Level-funded plans, while also benefiting from some regulatory advantages, might not offer the same level of freedom from state regulations.

  • Understanding Regulations: Navigating the regulatory environment can be complex. Partnering with an expert like NPA Benefits can help ensure that your business complies with all relevant laws and regulations.

NPA Benefits

  • Expert Guidance: Choosing the right health insurance plan for your business can be daunting. NPA Benefits has the expertise to guide you through the process, helping you understand the pros and cons of each option.

  • Tailored Solutions: NPA Benefits can help you tailor a health insurance solution that meets the specific needs of your business and your employees. Whether you’re leaning towards a level-funded or self-funded plan, they can provide the support and advice you need.

Choosing between level-funded and self-funded plans depends on your business’s specific needs and circumstances. Consider your company’s size, how much risk you’re willing to take on, your desire for flexibility and control, and the regulatory environment. Consulting with experts like NPA Benefits can provide valuable insights and help you make an informed decision that benefits both your business and your employees. Moving forward, we will address some frequently asked questions about level-funded and self-funded plans to further assist in your decision-making process.

Frequently Asked Questions about Level-Funded and Self-Funded Plans

Navigating health insurance can be like trying to find your way through a maze. But don’t worry, we’re here to light the path and answer some common questions about level funded vs self funded plans.

What is the difference between self-funded and level-funded plans?

Self-funded plans mean the employer pays directly for employees’ healthcare costs as they arise. It’s like cooking at home; you buy what you need, when you need it, but sometimes you might have unexpected guests and need more food than planned. This can be risky because costs can vary widely month to month.

On the other hand, level-funded plans are a bit like a set menu at a restaurant with an emergency dish in the back, just in case. You pay a fixed monthly amount, and if your costs go over what you’ve paid for, stop-loss insurance kicks in to cover the extra. This gives you more predictable costs and a safety net for high claims.

How can a business switch to a level-funded plan?

Switching to a level-funded plan can seem daunting, but it’s like learning to ride a bike with training wheels before you go full speed. Here’s a simple guide:

  1. Consult the Experts: Talk to knowledgeable partners like NPA Benefits who understand your business’s unique needs.
  2. Analyze Your Needs: Look at your current health plan’s performance and employee needs. Are you paying too much? Could you benefit from more flexibility?
  3. Get Proposals: Don’t settle for the first option. Compare proposals from several providers to find the best fit.
  4. Design Your Plan: Work with your chosen provider to customize the plan design that meets your employees’ needs.
  5. Educate Your Team: Make sure your employees understand the new plan. Clear communication is key to a smooth transition.
  6. Implement and Review: Launch your new plan and regularly review its performance to ensure it meets your expectations.

Are there tax advantages to choosing a level-funded plan over a self-funded plan?

Yes, there are tax perks to going with a level-funded plan. Because level-funded plans are considered fully insured for tax purposes, they can be exempt from certain state taxes that self-funded plans must pay. This can lead to lower overall costs. Think of it as a discount on your bill just for choosing a different payment method.

Every business is unique, and what works for one may not work for another. It’s always best to consult with experts like NPA Benefits to get advice tailored to your specific situation. They can help you weigh the pros and cons, ensuring you make the best decision for your business and your team.

As we wrap up this section, the journey to finding the right health plan can be smoother with the right guide. Whether you’re considering level-funded or self-funded options, the goal is always to provide quality healthcare benefits that support your employees’ well-being and your company’s bottom line.


Choosing the right health insurance plan for your business is a crucial decision that can impact not just your financial health, but also the well-being of your team. The comparison between level funded vs self funded plans reveals a spectrum of options, each with its unique benefits and challenges.

Level-funded plans offer a middle ground, providing the predictability of fixed monthly costs with the possibility of savings if claims are lower than expected. They allow for customization and give you access to detailed claims data, which can be invaluable for managing health costs effectively. However, they also come with the need for diligent plan administration and an understanding of the compliance requirements.

On the other hand, self-funded plans put you in the driver’s seat, with more control over plan design and the potential to retain any surplus funds not spent on claims. This model can offer significant savings but comes with the risk of unpredictable costs and the potential for high-cost claims.

So, how do you decide which plan is right for your business? Consider factors such as:

  • The size of your business and your ability to manage financial risk
  • Your company’s healthcare costs and claims history
  • Your desire for flexibility and control over your health plan
  • The regulatory environment in your state

At NPA Benefits, we understand that navigating the health insurance landscape can be complex. That’s why we’re here to help you understand your options and make an informed choice that aligns with your business goals and values. Our team of experts is ready to guide you through the process, offering insights and support every step of the way.

The best health plan is one that balances cost with care, ensuring your employees have access to the health benefits they need while keeping your financial health in check. Choosing the right plan is not just a financial decision; it’s an investment in your team’s health and your company’s future.

Let us help you make that investment wisely. Reach out to us at NPA Benefits, and together, we’ll find the health insurance solution that’s right for you and your team.

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