Accept the 2027 Increase or Price Level Funding? A Washington Employer's Decision Guide

The 2027 numbers behind your renewal

Source: Washington OIC, small group. Source: Washington OIC, individual market.

If you offer a fully insured group plan, the small-group figure is your benchmark. If your employees buy their own coverage, or you reimburse it through an ICHRA, the individual figure is the one reaching your people. Both averages describe markets, not your business. Your renewal still depends on your carrier, plan and enrollment.

Why a level-funded quote can land somewhere else

A fully insured small-group renewal is priced from the carrier's filed rates. Standard ACA small-group rating does not use a group's medical history or claims experience. Source: CMS market-rating guidance.

A level-funded plan works the other way. In KFF's description, these arrangements pair a relatively small self-funded component with stop-loss insurance. The survey points out that, unlike insured plans, they rate and underwrite using health status, and they need not include every essential health benefit required of insured plans. More than a third of covered workers at firms of 10 to 199 workers, 37%, were enrolled in one in 2025. Source: KFF 2025 Employer Health Benefits Survey.

In practice, that means a healthier group can see a level-funded price below its renewal, while a group carrying expensive recent claims can be quoted above it or turned down. The only way to know is to request the quote.

Three tests before you request quotes

Size. Minimums vary by carrier and enrolled headcount. Among the carriers we work with, Angle Health and Nationwide start at 2 employees, Cigna starts at 25, and UnitedHealthcare rounds out the list. Enrolled employees, eligible employees and total headcount are different counts, so confirm which one each carrier uses.

Underwriting. Expect to supply a census, plus health questionnaires or a claims history if the carrier asks for them. Questionnaires should go through the carrier's secure process, never a general contact form or HR inbox.

Capacity. Under federal law, level funding is generally treated as self-funding, which makes the business the plan sponsor. Vendors handle most administration, but someone at the company needs to own plan documents, notices and the year-end settlement. If no one can, a fully insured renewal may be the better fit.

Compare on a no-refund budget

Put a full year of scheduled level-funded payments, plus any fees outside the quote, against a full year of the fully insured renewal. Any surplus refund stays out of the budget.

Hypothetical illustration (not a quote): A business pays $18,000 a month for a fully insured plan. A 16.7% renewal raises that to $21,006, or $252,072 for 2027. A level-funded proposal for the same census costs $19,800 a month: $14,000 to the claims fund, $4,100 for stop-loss and $1,700 for administration.

The refund share in this example is invented for illustration. Real contracts differ on the share returned, deductions, timing and whether you must renew to receive it. If the level-funded option only wins after an assumed refund, it isn't winning. Our seven contract questions cover maximum liability, attachment points and run-out claims in detail.

Think about year two before you sign

A level-funded price follows your claims. A good year can improve your next renewal; a difficult one can raise it, sometimes beyond what a fully insured renewal would have been. Ask each carrier how renewals are set and whether stop-loss terms can change.

Your exit route matters too. Federal rules require insurers to let employers buy fully insured group coverage at any point during the year. Groups that can't meet an insurer's contribution or participation rules may be limited to a November 15 to December 15 window. Source: 45 CFR 147.104. Before returning, plan for run-out claims, meaning claims for care before you left that are paid afterward, and for any refund you might give up by leaving.

If your employees are on the Exchange today

Businesses without a group plan feel the 22.2% through their employees, and businesses with an ICHRA feel it through allowances that buy less coverage in 2027. Pricing a level-funded group plan is a reasonable response. Look at each employee's situation first, because HealthCare.gov warns that an affordable job-based offer meeting minimum standards usually removes Marketplace savings, whether or not the employee enrolls. Source: HealthCare.gov. Our employee cost test shows how to model household-level results.

What to send for a side-by-side comparison

• Your 2027 renewal, current Summary of Benefits and Coverage and contribution schedule
• An employee census with coverage tiers and home ZIP codes
• Any claims reports your current carrier provides
• Must-keep providers and prescriptions, gathered privately, so we can audit networks before price

Start before the renewal decision becomes urgent. Underwriting, employee questions, enrollment and payroll setup all take time, and each carrier sets its own deadlines for a given start date.

Get a second price before you sign

Benefit Experts gathers level-funded proposals from Angle Health, Cigna, Nationwide and UnitedHealthcare and lays them beside your fully insured renewal and other group health options. We show the no-refund cost first, then the good-year and hard-year scenarios, so you can decide with clear eyes.

Call 206.556.2993 or request a benefits review.

Common employer benefits questions