Compare self-funded, level-funded, and fully-insured health plan options. Determine which funding approach is right for your client with break-even analysis and risk assessment.
Traditional insurance where carrier assumes all risk
Hybrid with fixed payments and potential refunds
Employer pays claims directly with TPA administration
| Factor | Fully-Insured | Level-Funded | Self-Funded |
|---|---|---|---|
| Group Size | Fully-Insured | Level-Funded | Self-Funded |
| Risk Tolerance | Fully-Insured | Level-Funded | Self-Funded |
| Cash Reserves | Fully-Insured | Level-Funded | Self-Funded |
| Claims History | High claims = FI | Average = LF | Low claims = SF |
| Plan Flexibility Need | Low = FI | Medium = LF | High = SF |
| HR Sophistication | Limited = FI | Moderate = LF | Advanced = SF |
Protects against high individual claims. Once a single claimant exceeds the specific deductible (e.g., $50,000), stop-loss reimburses the excess.
Caps total annual claims. If total claims exceed a predetermined corridor (typically 125% of expected), stop-loss reimburses the excess.
Planlined lets you compare fully-insured, level-funded, and self-funded options side-by-side with accurate contribution modeling.
Continue learning with these helpful resources
Learn how level-funded health insurance works. Understand the benefits, risks, and when level-funded plans make sense for your clients.
Calculate stop-loss insurance needs for self-funded plans. Determine optimal specific and aggregate deductibles. Free calculator for benefits brokers.
Plain-English definitions of the terms brokers meet in quotes, renewals and compliance: level-funded, stop-loss, MLR rebate, ACA affordability, SBC, composite rates, ICHRA and more, each linked to the Planlined guide or calculator that goes deeper.