Instead of paying a full health insurance premium each month, you pay each individual claim as it is received by a third party administrator.

To protect against catastrophic claims (trauma, cancer) you buy stop loss insurance at a specific deductible. For a 100 person company, this might be $35,000. For each person on the plan, this "stops" your exposure once this amount is reached.

Self-insurance is the ultimate way to take control of your employee health plan, because you get to decide the exact benefits design, the collection of vendors, and you have total visibility into all costs that make up your total health plan spend.

Components of a self-funded plan include:

• Benefits design
• Third-party administration
• Stop loss insurance
• Utilization review/prior-authorization
• Medical and pharmacy network
• AI-driven care
• Direct primary care
• Compliance (plan document and notice filings)

Optimizing a self-insured plan can save you 20% from your baseline.

Works best for 100+ employees

Small group is the default for employers with 50 or under employees.

It's difficult to control premium rates since this market segment is "community rated" which means your rates are only determined by employee age and location.

Employers seeking to reduce costs have three options:

1. Shop between different carriers (each carrier has different rate increases each year).

2. Explore different benefit designs, such as HSA-compatible plans.

3. Consider switching to an ICHRA.

Works for 3-50 employees