A middle path between fully insured and self-funded.
On a fully insured plan you pay a premium and the carrier keeps whatever it does not spend. On a self-funded plan you pay claims as they come and carry the risk yourself. A level-funded plan sits between the two.
Your group pays a set amount each month covering three things: expected claims, plan administration, and stop-loss insurance. The stop-loss coverage is the part that matters most — it caps the downside, so a bad claims year does not become an unlimited bill.
Rates stay fixed through the plan year. If claims come in under what was funded, a share of the surplus can be returned at year end. If claims run high, stop-loss absorbs the excess and your monthly cost still does not change mid-year.
It does not fit every group. Where it does not, we will say so rather than push it.
What you gain and what you take on.
What you gain
Fixed monthly cost through the plan year. Claims reporting, so you walk into renewal knowing what actually happened instead of reacting to a letter. Potential refund of unused claims funding. Often lower cost than a comparable fully insured plan for a healthy group, and relief from some state premium taxes and mandates.
What you take on
Underwriting. Your group has to qualify, which usually means health questionnaires or claims history. Rates are tied to your group’s actual experience, so a genuinely high-claims group may do worse than on a community-rated plan. And there is more to understand — which is only a problem if nobody explains it.
How a level-funded quote works.
Underwriting review
Employee health questionnaires or prior claims data go to the carrier to determine whether the group qualifies and at what rate.
Side-by-side
We compare the level-funded quote against your current fully insured rates on total annual cost, not just the monthly figure.
Stop-loss explained
We walk through the specific and aggregate stop-loss levels in plain numbers so you know exactly where your risk stops.
Reporting set up
Monthly claims reporting so you can see the plan’s performance during the year rather than learning about it at renewal.
Level-funded, answered.
Is level-funded risky?
The risk is mitigated by stop-loss coverage, which is built into the monthly amount. Your cost is fixed through the plan year regardless of claims. The real variable is renewal — a high-claims year can produce a larger increase than a community-rated plan would.
What size group qualifies?
Availability varies by carrier, and some will look at groups well under fifty employees. Qualification depends more on the health profile of your census than on headcount alone. The only way to know is to run the underwriting, which costs nothing.
Do we actually get money back?
If claims come in below the amount funded, a share of the surplus can be refunded, subject to the contract terms. It is a real feature, not a guarantee — treat it as upside rather than budgeted income.
What happens if we have a terrible claims year?
Stop-loss absorbs claims above the attachment points and your fixed monthly payment does not change mid-year. The consequence shows up at renewal, where your rates reflect your experience.
Can we go back to a fully insured plan?
Yes, at renewal. Groups do move in both directions. It is worth going in with a clear view of what would make you switch back.
The rest of the package.
Group Health
Medical coverage across every major Washington carrier.
Read more →Group Dental
The benefit employees use every year and rate highest per dollar.
Read more →Group Vision
Exams, frames and contacts — inexpensive, and always noticed.
Read more →Group Life & Disability
Income protection that costs a fraction of medical.
Read more →Voluntary Benefits
Employee-paid coverage, often at no cost to the company.
Read more →See whether your group qualifies.
Underwriting review costs nothing and tells you what a level-funded plan would actually cost.