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Many mid-market employers remain in fully insured arrangements simply because they've never had a viable alternative. These traditional structures offer minimal transparency into claims data, limited control over plan design, and premiums that rise regardless of your actual healthcare utilization.
The financial opportunity is significant. Fully insured employers typically overpay by 15-40% annually due to carrier profit margins, risk charges, premium taxes, and the inability to retain unused premium dollars. For a 200-employee organization with $2 million in annual healthcare spend, this represents $300,000-$800,000 in unnecessary costs every year.
Fully insured employers overpay annually due to carrier margins and premium taxes.
Typical savings before any plan optimization occurs.
For a 200-employee organization with $2M in annual healthcare spend.
From innovative care models in subsequent years.
We help leadership teams understand the fundamental differences between fully insured and self-insured models—emphasizing the cost advantages, control, data access, and long-term strategic flexibility that self-funding provides.
This includes selecting appropriate stop-loss coverage to cap exposure, establishing claim reserves, and building administrative frameworks that meet ERISA's fiduciary standards from day one.
Employers immediately eliminate carrier profit margins and premium taxes—typically saving 10-15% in year one before any plan optimization occurs. Beyond these immediate savings, you gain unprecedented visibility into where healthcare dollars actually go, the ability to design benefits around your workforce's specific needs, and the foundation to implement innovative care models that reduce costs by an additional 15-30% in subsequent years.
If your current health plan feels more like an unavoidable expense than a strategic asset, let's explore what's possible when incentives align, data becomes transparent, and fiduciary responsibility drives decision-making.
We begin every engagement with conversation, not quotation—because meaningful change starts with understanding where you are and where you want to go.
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