Self-Funding Employer Guide
Moving to a self-funded health plan is a significant decision that requires careful planning. This guide walks you through every step — from initial feasibility analysis through implementation and ongoing management.
Feasibility analysis
Assess whether self-funding makes sense for your organization. Analyze group size, claims history (if available), workforce demographics, and financial capacity. Run a plan cost model comparing self-funded vs. fully insured.
TPA selection
Your TPA is the most important vendor decision in a self-funded plan. Issue an RFP to 3–5 TPAs, evaluate their claims accuracy, network access, reporting capabilities, and fee transparency.
Stop-loss procurement
Work with a stop-loss broker to design your specific and aggregate coverage. Negotiate attachment points, laser limits, and contract terms. Get quotes from at least 3–5 carriers.
Plan document and compliance
Draft your Summary Plan Description (SPD) and plan document. Ensure ERISA compliance, ACA reporting requirements, and state-specific obligations are addressed.
Member communication
Communicate the change to employees clearly and proactively. Address concerns about network access, claims processing, and how the plan differs from their previous coverage.
Ongoing management
Self-funding is not a set-it-and-forget-it strategy. Review claims data monthly, manage utilization, benchmark performance, and continuously evaluate cost-containment opportunities.