Level-Funded Health Plans: A Complete Employer Guide

Understand the core mechanics of level-funded health plans — how they differ from fully insured and self-funded plans, who they are designed for, and why they have become the fastest-growing segment of employer-sponsored health coverage.

• The Three-Tier Funding Spectrum8 min
• The Level Payment Anatomy: Where Your Money Goes10 min
• Who Level Funding Is — and Is Not — Designed For7 min

Stop-loss insurance is the mechanism that makes level funding viable for small and mid-size employers. This module covers specific vs. aggregate stop-loss, attachment points, lasering, run-in/run-out provisions, and how to evaluate whether your stop-loss coverage is actually protecting you.

• Specific vs. Aggregate Stop-Loss: Two Different Protections9 min
• Lasering: The Risk That Can Blindside You8 min
• Run-In, Run-Out, and Contract Continuity7 min

Level-funded plan pricing is not arbitrary. Carriers use a structured underwriting process to assess your group's risk and set the level payment. This module explains how underwriting works, what data carriers use, how to read a rate build, and how to negotiate more favorable terms.

• The Underwriting Process: What Carriers Are Really Evaluating9 min
• Reading a Rate Build: Decoding the Proposal10 min
• Negotiating Better Terms: What Is Actually Movable8 min

One of the most powerful advantages of level funding is access to your own claims data. This module covers how to read a claims report, identify cost drivers, use data to negotiate renewals, and build a data-driven cost-containment strategy.

• Understanding Your Claims Report9 min
• Using Data to Drive Renewal Negotiations8 min

Level-funded plans are self-funded plans for ERISA purposes, which means they come with a specific set of federal compliance obligations. This module covers ERISA plan document requirements, ACA compliance, HIPAA privacy rules, and the reporting and disclosure obligations that apply to your plan.

• ERISA Fundamentals for Level-Funded Plan Sponsors10 min
• ACA Compliance for Level-Funded Plans9 min
• Mental Health Parity, HIPAA, and Other Federal Mandates8 min

Level-funded plans give you plan design flexibility that fully insured plans do not. This module covers how to design a benefits package that balances cost, employee satisfaction, and compliance — including deductibles, copays, networks, and value-based benefit design strategies.

• Plan Design Fundamentals: Deductibles, Copays, and Cost-Sharing9 min
• Value-Based Benefit Design: Incentivizing Better Care8 min

Pharmacy costs are the fastest-growing component of employer health plan spending. This module covers PBM contracts, formulary design, specialty drug management, and strategies for controlling pharmacy spend without compromising employee health outcomes.

• How PBMs Work and Why It Matters9 min
• Specialty Drug Management: Controlling Your Biggest Pharmacy Risk9 min

Renewal is the most consequential event in the level-funded plan calendar. This module walks through the complete renewal process — from claims analysis and carrier negotiations to the final decision framework and implementation timeline.

• The 90-Day Renewal Timeline8 min
• Evaluating Renewal Proposals: A Decision Framework9 min

Level funding gives you the data and flexibility to implement cost-containment strategies that are simply unavailable in a fully insured plan. This module covers the most effective strategies for reducing claims cost without compromising employee health outcomes.

• The Cost-Containment Hierarchy: Where to Start8 min
• Reference-Based Pricing: The Advanced Cost-Containment Strategy9 min

Level-funded plans are more complex than fully insured plans — and that complexity can create confusion and anxiety for employees if not communicated effectively. This module covers how to explain level funding to employees, manage open enrollment, and build a communication strategy that drives engagement and reduces friction.

• Explaining Level Funding to Employees7 min
• Year-Round Benefits Communication7 min

Your broker is your most important partner in managing a level-funded plan. This module covers how to evaluate broker competency, understand compensation structures, set performance expectations, and build a relationship that delivers ongoing value — not just a once-a-year renewal.

• Evaluating Broker Competency for Level-Funded Plans8 min
• Setting Performance Expectations and Measuring Broker Value7 min

Level-funded plans have unique financial management requirements that differ from fully insured plans. This module covers cash flow planning, claims reserve accounting, surplus refund management, and the financial reporting obligations that come with operating a self-funded plan.

• Cash Flow Planning for Level-Funded Plans8 min
• Accounting for Level-Funded Plans7 min

Moving from a fully insured plan to a level-funded plan requires careful planning and execution. This module provides a step-by-step implementation roadmap covering vendor selection, contract review, employee communication, and the first 90 days of plan operation.

• The Implementation Roadmap: 120 Days to Launch9 min
• Common Transition Mistakes and How to Avoid Them7 min

When you go to market for a level-funded plan, you will receive proposals that are difficult to compare on an apples-to-apples basis. This module provides a practical framework for evaluating proposals, identifying red flags, and making a confident, data-driven decision.

• The Proposal Evaluation Framework9 min
• Contract Review: What to Look for Before You Sign8 min

The level-funded market is evolving rapidly. This final module covers advanced topics including captive arrangements, level-funded consortiums, emerging regulatory trends, and the future of employer-sponsored health coverage for small and mid-size employers.

• Captive Arrangements: The Next Step Beyond Level Funding9 min
• The Future of Level Funding: Trends and Emerging Developments8 min