Our Approach Services Self-Funding Results About Resources
Schedule a Consultation
Self-Funding

Stop renting your health plan.
Own it.

Self-funded health plans let employers pay for employees' healthcare costs directly — rather than paying fixed premiums to a carrier. You keep the money your employees don't spend, see every dollar of claims data, and control every aspect of plan design.

See If You're a Fit How It Works
Annual Cost Per Employee — 180-Life Group
Fully Insured
$11,670per employee
Fixed premium — paid regardless of claims. Carrier keeps any surplus.
Self-Funded
$10,050per employee
Pay actual claims. Unused funds return to your organization.
−14%
Cost reduction year one
$291K
Saved — 180 employees
100%
Claims transparency
How It Works

Self-funding in plain English

In a fully-insured plan, you pay a fixed premium every month regardless of what your employees use. In a self-funded plan, you pay actual claims as they occur — with stop-loss insurance to cap your exposure. The difference is transparency, control, and money left on the table that stays in your pocket.

Step 01 🔍
You fund a claims account
Instead of paying a premium to a carrier, you set aside funds monthly based on projected claims. Unused dollars stay with your organization — not the insurer.
Step 02 📋
A TPA administers your claims
A third-party administrator processes member claims against your plan design, applying your custom benefit structure and network access — all with full transparency.
Step 03 🛡
Stop-loss caps your risk
Specific stop-loss protects against any single large claim. Aggregate stop-loss caps your total annual liability. You get all the upside with your catastrophic exposure fully protected.
🏗
Self-Funded Plan Design

Built for your workforce,
not a carrier's template.

We architect self-insured health plans from the ground up — designed around your actual workforce demographics, utilization patterns, and financial goals. Every component is competitively bid and selected on merit, not carrier relationships.

Custom plan architecture — benefit levels, cost-sharing structures, and network design built specifically for your employee population.
Best-in-class TPA selection — we competitively bid third-party administrators to find the right fit for your size, network needs, and reporting requirements.
Full claims ownership — your data belongs to you. Monthly reporting gives you complete visibility into where every dollar goes.
Average 8% cost reduction in year one versus prior fully-insured arrangements, with compounding savings year over year as utilization is managed.
Annual Spend Comparison — 180-Life Group
$1.89M
Self-funded total cost vs. $2.1M fully insured — 10% savings
Pharmacy savings
−$84K
Admin & TPA fees
−$52K
Unused premium returned
+$75K
Stop-loss protection
Included
Total net savings year one
$211K
🛡
Stop-Loss Coverage

All the upside.
Catastrophic risk capped.

The most common concern about self-funding is exposure to large claims. Stop-loss insurance solves that — capping your liability on any individual claim and your total plan spend for the year. We competitively bid stop-loss across the market every renewal cycle, structuring coverage to match your risk tolerance and financial profile.

Specific stop-loss — protects against any single member's claims exceeding a set threshold, typically $50K–$200K depending on group size.
Aggregate stop-loss — caps your total plan liability for the year, giving you budget certainty even in a high-utilization year.
Carrier-agnostic bidding — we run a competitive RFP across the stop-loss market every renewal cycle to ensure you're never overpaying for coverage.
Laser risk management — proactive identification and management of high-risk members to protect your attachment points at renewal.
Stop-Loss Structure — Example Group
Specific Deductible
$100K
Any single claim above this threshold is reimbursed by stop-loss carrier
Aggregate Cap
125%
Total plan liability capped at 125% of expected annual claims
Competitive Bidding
Every Renewal
Stop-loss carriers evaluated and competitively bid every renewal cycle
Avg. Premium Savings
−12%
vs. prior stop-loss carrier when rebid competitively through our process
💊
Pharmacy Benefit Strategy

Pharmacy is your biggest
untapped opportunity.

For most employers, pharmacy represents 25–35% of total health spend — and it's the category with the most hidden cost. PBM spread pricing, buried rebates, and specialty drug markups can inflate your spend by 30–50% above what you should be paying. We replace opaque bundled arrangements with transparent, pass-through PBM contracts that put every dollar to work for your plan.

Transparent pass-through pricing — 100% of manufacturer rebates flow back to your plan, not to the PBM or broker.
Specialty drug carve-out programs — alternative sourcing channels for high-cost specialty medications can reduce specialty spend by 40–60%.
Formulary optimization — evidence-based formulary design that promotes cost-effective generics and therapeutic alternatives without compromising care.
Ongoing utilization review — monthly reporting flags high-cost drug trends and members who may benefit from clinical outreach or alternative therapies.
Pharmacy Spend — Before & After
−41%
Average pharmacy cost reduction in year one
Specialty drugs
−55%
Brand generics
−38%
PBM admin fees
−29%
Rebates returned
100%
🩹
Expanded Primary Care

Better primary care means
lower total cost.

When employees have easy, affordable access to a primary care physician, they use the ER less, get diagnosed earlier, manage chronic conditions better, and stay healthier overall. We integrate primary care partnerships — including Direct Primary Care (DPC) models — directly into your plan design to shift utilization toward the highest-value, lowest-cost setting.

Direct Primary Care (DPC) integration — flat-fee primary care membership giving employees unlimited access to a dedicated physician for a low monthly cost.
ER and urgent care diversion — same-day and next-day access eliminates unnecessary emergency room visits averaging $2,200 per visit.
Chronic condition management — proactive care coordination for members with diabetes, hypertension, and other high-cost conditions reduces downstream claims significantly.
Higher employee satisfaction — members with a trusted primary care relationship report better benefits satisfaction and measurably better health outcomes year over year.
Utilization Shift with DPC Integration
Avoidable ER visits
−34%
Unnecessary specialist referrals
−22%
Primary care visits
+48%
Preventive screenings completed
+61%
Employee satisfaction score
+29pt
Net cost impact per member/yr
−$680
Full Comparison

Self-funded vs.
fully insured

Self-funding isn't right for every employer — but for groups over 100 lives, it almost always is. The table to the right shows exactly where the differences show up in practice.

We exclusively serve employers with mid-market employers. If that's you, there's a very good chance we can improve your plan and reduce your cost in year one.

See if you're a fit
📊 Data & Visibility
Fully InsuredNo claims data
Self-FundedFull transparency
💰 Unused Premiums
Fully InsuredCarrier keeps it
Self-FundedReturned to plan
🎛️ Plan Control
Fully InsuredCarrier templates
Self-FundedFully custom
💊 Pharmacy
Fully InsuredHidden rebates
Self-FundedPass-through PBM
📈 Cost Trend
Fully Insured8–15% increases
Self-FundedData-driven
🤝 Broker Model
Fully InsuredCommission-based
Self-FundedFee-based, disclosed
Best fit: mid-market employee groups
Self-funding almost always wins above 100 lives
8 of 8 ✓
Get Started

Find out what self-funding could save you.

Schedule a no-obligation consultation. We'll analyze your current plan, model your savings opportunity, and show you exactly how a self-funded strategy would work for your organization.

Schedule a Consultation See Our Services

No pressure. No commitment. Just a conversation.