Self-Funded Group Health Insurance Plans

Take Full Control of Your Group Health Benefits with a Self-Funded Plan

In a self-funded plan, the employer assumes financial responsibility for employee healthcare claims rather than paying fixed premiums to an insurance company. Employers typically partner with a third-party administrator (TPA) to process claims, access networks, and handle compliance.

Employers often purchase stop-loss insurance to protect against catastrophic claims, either at the individual (specific) or group (aggregate) level.

Benefits of Self-Funded Group Health Insurance Plans

Cost Savings Potential – Employers keep surplus funds if claims are lower than expected

Full Plan Control – Design benefits, networks, and deductibles to meet workforce needs

Transparency – Direct access to claims data helps identify cost drivers



Flexibility – Coverage can be adapted as business and employee needs evolve

What to Consider When Choosing a Self-Funded Group Health Insurance Plan

Financial Risk – Employers must cover claims, which can be unpredictable

Administrative Complexity – Requires more oversight, usually managed through a TPA

Regulatory Compliance – Governed by ERISA and federal rules, requiring proper filings



Cash Flow Demands – Employers need the financial capacity to pay claims as they occur