Research Methodology
How We Research Self-Funded Health Plans
Every article, tool, and vendor profile on this cluster is built on a defined research process. This page documents our editorial standards, data sourcing, readiness assessment methodology, TPA evaluation criteria, and the limitations of our AI-assisted analysis — so you can evaluate our work with full transparency.
01 — Editorial Standards
What we publish and why
EmployerBenefitsIQ.com is an independent employer-focused research and education platform. We do not accept vendor advertising, sponsored content, or affiliate fees that influence editorial coverage.
Independence
No vendor pays for placement, positive coverage, or editorial access. Vendors are profiled based on market presence and employer relevance, not commercial relationships.
Primary sources
We cite DOL, IRS, CMS, and ERISA Advisory Council guidance directly. Regulatory interpretations are attributed to source documents, not secondary summaries.
Practitioner review
Technical content is reviewed by benefits attorneys, actuaries, and experienced plan sponsors before publication. Reviewer credentials are disclosed where applicable.
Update cadence
Regulatory content is reviewed after each IRS, DOL, or CMS guidance release. Vendor profiles are reviewed annually or when material changes are reported.
02 — Readiness Assessment
How we evaluate self-funding readiness
Our Self-Funding Readiness tool scores employers across seven factors that actuaries and benefits consultants use to determine whether self-funding is appropriate for a given group.
| Factor | Weight | Methodology note |
|---|---|---|
| Group size | High | 100+ lives is the practical minimum; 200+ for predictable experience |
| Claims history | High | 3 years of fully insured claims data is the gold standard for underwriting |
| Industry & workforce | Medium | Age distribution, gender mix, chronic condition prevalence |
| Cash flow capacity | High | Ability to fund monthly claims run-rate without disruption |
| Risk tolerance | Medium | Board/ownership appetite for claims volatility above stop-loss |
| HR/benefits staff | Medium | Internal capacity to manage TPA, PBM, and compliance obligations |
| Renewal timing | Low | Transition mid-year is possible but adds complexity |
Readiness scores are heuristic estimates based on population-level actuarial research. They are not a substitute for a group-specific feasibility study from a licensed actuary or benefits consultant. The tool is calibrated to flag groups where self-funding is clearly premature — not to certify that self-funding is appropriate.
03 — TPA Evaluation
How we profile third-party administrators
TPA profiles on this cluster are built from public information, employer-reported experience, and RFP response patterns. We do not accept TPA-sponsored content.
Claims processing accuracy
Error rate, repricing accuracy, and audit trail quality
Network access & steerage
PPO network breadth, RBP capability, COE partnerships
Reporting & data access
Real-time claims data, custom reporting, HIPAA-compliant feeds
Compliance support
ACA reporting, ERISA plan documents, COBRA administration
Stop-loss coordination
Laser management, advance funding, run-in/run-out handling
Implementation & service
Onboarding timeline, dedicated account management, SLAs
Financial stability
Ownership structure, reinsurance, financial reserves
Technology platform
Member portal, mobile app, EDI capabilities, integrations
04 — Benchmark Data
Where our benchmark data comes from
Self-funded plan benchmarks are drawn from publicly available surveys and regulatory filings. We do not manufacture benchmark data.
Kaiser Family Foundation / HRET Employer Health Benefits Survey
Annual survey of 2,000+ employers; primary source for premium, deductible, and cost-sharing benchmarks.
EBRI / Greenwald Research Workplace Wellness Survey
Employee-side data on plan satisfaction, affordability, and access to care.
Mercer National Survey of Employer-Sponsored Health Plans
Large-employer benchmarks for plan design, cost trends, and self-funding prevalence.
HCCI (Health Care Cost Institute) Employer-Sponsored Insurance Data
Claims-level data on utilization and spending patterns across self-funded plans.
DOL Form 5500 filings
Public regulatory filings used to verify self-funded plan prevalence and TPA market share.
CMS Medical Loss Ratio data
Carrier-level data used to contextualize fully insured vs. self-funded cost comparisons.
Benchmark figures are presented as ranges, not point estimates, to reflect the variation across employer size, industry, and geography. We cite the survey year and sample size wherever benchmarks are presented.
05 — AI Analysis
How AI is used in self-funded plan tools
Several tools on this cluster use GPT-4o to generate employer-specific analysis. This section documents what the AI does, what it does not do, and how outputs should be used.
What AI does
- Synthesizes structured vendor profile data into narrative analysis
- Identifies alignment between employer context and vendor capabilities
- Flags fields marked "Verify in RFP" that require direct confirmation
- Generates employer-specific questions for TPA and stop-loss RFPs
What AI does not do
- Access real-time pricing, contract terms, or live vendor data
- Provide legal, actuarial, or fiduciary advice
- Verify vendor claims or audit vendor performance
- Replace a licensed benefits consultant or ERISA attorney
06 — Limitations
What this research cannot tell you
Transparency about what our methodology does not cover is as important as what it does.
Group-specific actuarial analysis
Our readiness tools use population-level heuristics. A licensed actuary reviewing your specific claims history, demographics, and stop-loss quotes will produce a more accurate feasibility assessment.
Real-time vendor pricing
TPA, stop-loss, and PBM pricing is negotiated and changes frequently. No published benchmark accurately reflects what a specific vendor will quote your group.
Legal and fiduciary advice
Nothing on this site constitutes legal advice, ERISA fiduciary guidance, or a recommendation to take or refrain from any specific plan action. Engage qualified ERISA counsel for plan design and compliance decisions.
Claims-level performance data
We do not have access to individual TPA or carrier claims performance data. Vendor profiles reflect publicly available information and employer-reported experience, not audited performance metrics.
State-specific regulatory nuance
Self-funded ERISA plans are generally exempt from state insurance mandates, but state law affects stop-loss regulation, COBRA mini-COBRA, and certain benefit mandates. State-specific guidance requires local counsel.