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Benefits of Level-Funded Health Insurance for Small Businesses




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Managing expenses while offering competitive incentives to draw and keep top people for small businesses can be difficult. Health insurance is one of the most important perks that small businesses can provide, among many others. Small firms have historically had few options, sometimes confined to fully insured plans or self-funded plans, each with pros and downsides. On the other hand, level-funded health insurance is becoming more popular due to its ability to combine the potential cost reductions of self-funded plans with the dependability of fully insured plans.

What is Level-Funded Health Insurance

Level-funded health insurance, sometimes referred to as a partially self-funded health plan, is a hybrid between traditional fully insured plans and self-funded plans. Employers pay a fixed monthly premium with level-funded plans, just like fully insured plans. However, this premium comprises three parts: the cost of administrative services, the cost of stop-loss insurance (to protect against high claims), and a claims fund. The claims fund is used to pay for employees’ actual medical claims.

At the end of the year, if the claims paid out are less than what was projected and contributed to the claims fund, the surplus can be refunded to the employer or rolled over to the following year. This provides an opportunity for savings that fully insured plans typically do not offer.

Key Benefits of Level-Funded Health Insurance

1. Cost Predictability and Stability

One of the most significant advantages of level-funded health insurance is its predictability. Small businesses often need more time to opt for self-funded plans due to the unpredictable nature of healthcare claims, which can fluctuate drastically. Level-funded plans mitigate this risk by setting a fixed monthly payment that covers anticipated claims, administrative costs, and stop-loss insurance. This stability is akin to fully insured plans but with the added benefit of potential cost savings.

2. Potential for Savings and Refunds

Unlike fully insured plans, in which the insurance company retains any unspent funds, level-funded plans offer the potential for financial rewards. If the actual claims are lower than expected, the remaining funds in the claims account can be returned to the employer. This can significantly reduce the overall cost of providing health insurance, making it a financially attractive option for small businesses.

3. Enhanced Cash Flow Management

Level-funded plans can improve cash flow management for small businesses. Knowing the monthly health insurance costs helps businesses better plan and allocate their budgets. The ability to predict healthcare costs more accurately helps maintain a stable financial outlook.

4. Customization and Flexibility

Level-funded health insurance plans offer a higher degree of customization compared to traditional fully insured plans. Small businesses can tailor their plans to suit the needs of their workforce better. This flexibility can lead to more relevant and appreciated employee benefits, thus boosting morale and retention.

5. Access to Claims Data

One critical advantage of level-funded plans is their access to claims data. This data allows businesses better to understand their employees’ health needs and usage patterns. With this information, employers can make more informed decisions about future health plan designs, wellness programs, and other initiatives to improve employee health and reduce costs.

6. Regulatory Advantages

Level-funded plans often benefit from more favorable regulatory treatment than fully insured plans. For instance, these plans can be exempt from specific state regulations and premium taxes that apply to fully insured plans, which can further reduce costs. Moreover, they are governed by federal ERISA laws, which can offer more uniformity and predictability across state lines.

Considerations and Potential Drawbacks

While level-funded health insurance offers numerous benefits, small businesses must consider the potential drawbacks and ensure it aligns with their needs and circumstances.

Initial Financial Assessment

Implementing a level-funded plan requires a thorough financial assessment. Small businesses must ensure they understand their workforce’s health needs and the financial stability to handle potential variability in claims costs despite the level of funding mechanism.

Risk of Higher-than-Expected Claims

Although stop-loss insurance provides protection, there is still a risk if claims exceed expectations significantly. This can lead to higher premiums in subsequent years. Businesses must carefully evaluate their risk tolerance and ensure they are adequately protected.

Complexity and Administrative Burden

Level-funded plans can be more complex to manage than fully insured plans. The administrative tasks associated with managing claims data, wellness programs, and stop-loss insurance can require additional resources and expertise. Small businesses need to assess whether they have the necessary infrastructure or if they will need to partner with third-party administrators.


Level-funded health insurance represents a promising option for small businesses looking to offer competitive health benefits while managing costs effectively. By combining the predictability of fully insured plans with the potential savings and flexibility of self-funded plans, level-funded health insurance can provide significant advantages. Small businesses can benefit from cost stability, possible refunds, improved cash flow management, and better insight into their employees’ health needs.

However, businesses must conduct a thorough evaluation and consider their specific circumstances and workforce needs. With careful planning from The CBC Health Insurance Marketplace for Costco Members, level-funded health insurance can be valuable in attracting and retaining talent, fostering a healthier workforce, and achieving financial stability.

I am a seasoned content writer and accomplished professional blogger. With a wealth of experience, I create captivating content that resonates. From insightful articles to engaging blog posts, I bring expertise and creativity to every project.


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