Plan financing. How your plan is paid for.
Fully insured, level funded, self-funded, captives and reference-based pricing: how each way of paying for a health plan changes cost and risk.
Start with the main guide
How does self-funded health insurance work?
Self-funded health insurance is a health plan where the employer pays employees' medical claims from its own money instead of buying a fully insured policy. A third-party administrator processes the claims, a pharmacy benefit manager runs the drug benefit, and stop-loss insurance reimburses the employer when claims pass set limits.
Read the guideIn this guide
- What is self-funded health insurance?
- How does the money flow?
- Which vendors does a self-funded plan use?
- What does the employer have to do?
- What data does the plan own?
- Which claims does stop-loss cover?
- Who does self-funding fit?
Guides 7
- Level funded vs. fully insuredPlan financingGuide
- Level funded vs. self-fundedPlan financingGuide
- Self funded vs. fully insuredPlan financingGuide
- Self-funded health insurance pros and consPlan financingGuide
- Self-funded healthcare trustsPlan financingGuide
- What is level-funded health insurance?Plan financingGuide
- What is reference-based pricing?Plan financingGuide
See what your plan is really costing you.
A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.