Tool
Self-Funding Playbook
EMPLOYERS & BUSINESSES
Take Control of Costs with Data-Driven Self-Funding
Whether shifting from fully insured, refining self-funding, or exploring captives, OneDigital’s Center of Excellence offers guidance, benchmarking, and performance controls.
A Self-Funded COE Designed for Cost Clarity and Control
Strategic Planning
Build a Smarter Self-Funded Plan
Our self-funded COE begins with deep plan modeling and benchmarking. We evaluate cost drivers, utilization, and market standards to help you craft the right level-funded plan or custom self-funded health plan that balances savings with member experience.
Self-Funded COE, FAQs
Employers considering self-funding often ask these key questions about our center of excellence, funding strategies, and outcomes.
A self-funded (or self-insured) health plan is one where the employer assumes the financial risk of providing health benefits directly, as opposed to purchasing coverage from an insurance carrier. This approach provides greater control over plan design, funding, and healthcare spend but also requires careful planning for claim variability and risk management. Self-funding allows businesses to manage their health plans more efficiently and tailor them to their specific needs.
Self-funded plans work best for employers who want more control over plan design, access to claims data, and a higher potential for cost savings. Historically, self-funded health plans have been the domain of larger companies. However, as healthcare costs continue to rise, self-insurance has emerged as a viable and cost-effective option for employers of all sizes. Self-funded plans offer flexibility, allowing companies to control the level of risk they are comfortable with, unlike traditional plans where the insurance carrier dictates risk tolerance. With proper planning and the right strategy, self-funded plans can be a secure and beneficial option for businesses of all sizes.
Employers should select a qualified broker or consultant, to assess their risk profile, draft tailored benefit designs, and arrange for plan administration through a third-party administrator (TPA). Additional setup steps include negotiating stop-loss coverage, planning enrollment, and establishing reserves or funding strategies for claims. The key is to have a knowledgeable consulting team that understands the challenges and can proactively manage the plan to benefit the company. This expertise ensures that the complexity is managed effectively, allowing businesses to focus on their core operations.
Self-funded health plans enable employers to access detailed and real-time claims, utilization, and plan performance data, which is often limited in fully insured arrangements. This transparency helps organizations identify cost drivers, benchmark spending, monitor the impact of plan design changes, and make proactive, evidence-based decisions to optimize both costs and employee health outcomes. Unbundled self-funded plans are at the farthest end of the risk-protection spectrum due to the level of control employers gain by moving fully away from the bundled medical carrier arrangement. Unbundling allows employers to pick “best in class” providers to administer their health plans; this can result in some additional administrative lift on the employer’s end, but typically yields the highest level of savings. Employers with unbundled plans have the option to pursue proactive strategies like reference-based pricing, insurance group captives, and carved-out pharmacy benefit managers.
Although self-funding offers flexibility and cost reductions, employers assume liability for healthcare claims. Protection strategies like stop loss coverage are valuable and necessary product for all business owners who offer health benefits to their employees. With stop loss coverage in place, your company is protected because the stop loss carrier is responsible for reimbursement of any losses that go over a set employee deductible limit. By outsourcing the inherent financial risk of health plans, these policies enable businesses to remain financially solvent in the event of large claims and provide insurance to all eligible employees at a reasonable cost.
Contact Us
