Benefit
Health Advisor

Self-Funding vs. Fully-Insured

Benefit Health Advisor has a
deep understanding of our
clients’ needs. Each group
faces different challenges and
cost pressures in their
marketplace. Benefit Health
Advisor is a full-service
employee benefits firm.
As such, we can provide all
available options to our clients including custom self-funded plans, bundled selffunded
plans, and fully-insured plans. Each type of benefit plan meets different
needs for different clients.
Information Technology Solutions
General Guidelines and Differences
Plan Components: All components of a fully-insured plan are provided by the same
company. With a self-funded plan, each portion of the benefits plan is selected from a
number of specialized vendors providing the most relevant choice to the employer at the
least cost.
Reserve Handling: Premiums are paid at the beginning of every month with fully-insured
plans and the insurance carrier manages and retains any excess claims funds set aside for
benefit payments. With a self-funded plan, the employer keeps any excess claims funds that
were reserved for benefit payments.
Plan Design: Fully-Insured plan designs are set by the insurance carrier in pre-determined
benefit plans. Self-Funding allows benefit levels to be customized to meet the employer’s
needs and can be changed at the employer’s request.
Provider Access: Most insurance companies have
their own national network which provides access to
providers at discounted prices. With a self-funded
plan, the employer chooses the provider network that
gives the best access and claim discounts..
Plan Continunity: In order to switch carriers for
more competitive fully-insured rates, all aspects of
the plan must be switched to the new carrier.
Unbundled self-funding allows an employer to
change reinsurance carriers to obtain the best rates
without changing the claim processor, providing
greater stability and continuity to the plan and plan
Benefit Health Advisor has a
deep understanding of our
clients’ needs. Each group
faces different challenges and
cost pressures in their
marketplace. Benefit Health
Advisor is a full-service
employee benefits firm.
As such, we can provide all
available options to our clients including custom self-funded plans, bundled selffunded
plans, and fully-insured plans. Each type of benefit plan meets different
needs for different clients.
Information Technology Solutions
General Guidelines and Differences
Plan Components: All components of a fully-insured plan are provided by the same
company. With a self-funded plan, each portion of the benefits plan is selected from a
number of specialized vendors providing the most relevant choice to the employer at the
least cost.
Reserve Handling: Premiums are paid at the beginning of every month with fully-insured
plans and the insurance carrier manages and retains any excess claims funds set aside for
benefit payments. With a self-funded plan, the employer keeps any excess claims funds that
were reserved for benefit payments.
Plan Design: Fully-Insured plan designs are set by the insurance carrier in pre-determined
benefit plans. Self-Funding allows benefit levels to be customized to meet the employer’s
needs and can be changed at the employer’s request.
Provider Access: Most insurance companies have
their own national network which provides access to
providers at discounted prices. With a self-funded
plan, the employer chooses the provider network that
gives the best access and claim discounts..
Plan Continunity: In order to switch carriers for
more competitive fully-insured rates, all aspects of
the plan must be switched to the new carrier.
Unbundled self-funding allows an employer to
change reinsurance carriers to obtain the best rates
without changing the claim processor, providing
greater stability and continuity to the plan and plan

Benefit Health Advisor has a deep understanding of our clients’ needs. Each group faces different challenges and cost pressures in their marketplace. Benefit Health Advisor is a full-service employee benefits firm. As such, we can provide all available options to our clients including custom self-funded plans, bundled self-funded plans, and fully-insured plans. Each type of benefit plan meets different needs for different clients.


General Guidelines and Differences


Plan Components: All components of a fully-insured plan are provided by the same company. With a self-funded plan, each portion of the benefits plan is selected from a number of specialized vendors providing the most relevant choice to the employer at the least cost. 


Reserve Handling: Premiums are paid at the beginning of every month with fully-insured plans and the insurance carrier manages and retains any excess claims funds set aside for benefit payments. With a self-funded plan, the employer keeps any excess claims funds that were reserved for benefit payments.


Plan Design: Fully-Insured plan designs are set by the insurance carrier in pre-determined benefit plans. Self-Funding allows benefit levels to be customized to meet the employer’s needs and can be changed at the employer’s request.


Provider Access: Most insurance companies have their own national network which provides access to providers at discounted prices. With a self-funded

plan, the employer chooses the provider network that gives the best access and claim discounts.


Plan Continuity: In order to switch carriers for more competitive fully-insured rates, all aspects of the plan must be switched to the new carrier. Unbundled self-funding allows an employer to change reinsurance carriers to obtain the best rates without changing the claim processor, providing greater stability and continuity to the plan and plan participants.


Proper Risk 

Management

The experts at Benefit Health Advisor will be able to assist you in determining which benefits model best fits your organization’s specific situation. Our initial analysis will consider all relevant factors as we research all of the available options and plans available to you.



Proper Education

At Benefit Health Advisor, we are committed to helping you understand the different options available in order to make the best choice possible. We have helped hundreds of organizations transition from one benefits model to another and are prepared to assist you however we can.