Highlights  

• There has been an increase in self-funded insurance for small to midsize businesses.

• Many smaller companies still mistakingly believe they are too small for affordable self-funded insurance.

• Self-funded group captive plans make self-funding affordable for smaller companies. They enable businesses with 25 employees to leverage the same risk predictability as a Fortune 500 like General Motors.

• Self-funded insurance offers employers numerous benefits, ranging from cost containment to data transparency.

• Insuring your employees as part of a group captive eliminates the risks involved with self-funding.

Employee benefits, including healthcare insurance, have become increasingly important to attracting and retaining top talent in the workforce. Benefits quality can have significant impact when it comes to employee retention and attracting premium talent.

Traditionally, self-funding has only been an option for large companies. Companies employing 1,000 or more employees often choose to self-insure because it is the most cost-effective option. They only pay for the insurance they use – the costs they deserve to pay. Unused spend is not simply eaten up by the insurance company’s profits, as it is with fully-insured plans.

Small to midsize companies couldn’t afford the risk of self-funded insurance. They could not offset the expense if something catastrophic would happen to one or more members. With larger companies, that risk was more predictable because it was spread out among a greater number of employees.

More recently, group medical captives have made self-funding an affordable option for small and mid-size companies. Group medical captives pool smaller companies together so they can offset risk with the same leverage as a large corporation. Roundstone’s Group Medical Captive insures over 120,000 lives, enabling companies of only 25 employees to leverage the same risk offset as a Fortune 500 brand.

As a result, more small to midsize employers are turning to self-funded insurance. By self-insuring, employers can customize their plans to better meet the needs of their workforce. Self-insurance also delivers data transparency, which employers can use to optimize savings and improve care quality. Best of all, any unspent premiums are also returned. In 2022, Roundstone distributed $24.4M unspent captive premium pro rata.

Is Self-Funded Insurance Good for Employees?

The traditional model of employer-sponsored health insurance involves employers purchasing a group insurance policy from a fully funded insurance company to cover all eligible employees and their dependents. Yet this model has its drawbacks, including limited plan options and higher premiums based on the risk profile of the entire group.

Employers also have limited control over the benefits offered to their employees, as the insurance company administers the plan and makes decisions about covered services and procedures. This lack of control can lead to frustration for employers who want to tailor their plans to the unique needs of their workforce.

Self-funded insurance, also known as self-insurance, offers a flexible alternative to traditional fully funded insurance, making it an increasingly popular option for employers of large firms in recent years. Between 1999 and 2023, the percentage of employees covered by a self-funded plan rose from 44% to 65%.

Although many small businesses still believe that they do not have the resources to manage a self-funded plan, self-funded insurance is slowly being recognized as an affordable option for small and midsize businesses, thanks to the group medical captive model. Employees benefit by accessing higher quality, more affordable care that has less impact on wages and a company’s bottom line.

Because of its cost effectiveness, self-funding can reduce the amount employees must contribute to their health plans. This is an important factor for recruiting and retaining employees as part of their total benefits package.  Companies who self-insure also enjoy transparency.  They receive data-informed insights into costs and can do proactive cost containment measures to help employees get better care, and lessen impact of high-cost claims.

A great example of this is Roundstone itself. For the past 8 years, Roundstone has kept its own employee cost-share contributions flat, due to effective plan design and measures of cost control.

According to a survey conducted by the Kaiser Family Foundation, the percentage of small firms offering self-funded insurance rose from 13% in 1999 to 21% in 2021. This trend is driven by several factors, including the potential cost savings and greater control over benefits that self-funded insurance can provide. Small businesses are also increasingly becoming aware of self-funding insurance under a group medical captive model as a viable and affordable option.

Additionally, the Affordable Care Act (ACA), commonly known as Obamacare, has made self-funded insurance more accessible to smaller businesses by prohibiting insurance companies from charging higher premiums based on the health status of employees. This means that self-funded insurance has become a viable option for employers looking to provide quality employee benefits while managing costs.

What are the Benefits of Self-Funded Insurance with a Captive?

Self-funded health insurance in a group captive offers employers multiple benefits regarding control, cost, and coverage options. These include a risk-sharing arrangement, the return of unused premiums, and a flexible plan design.

Risk-Sharing

Self-insuring under the group medical captive model allows smaller employers to access the benefits of self-funded insurance while reducing their financial exposure to high-cost claims.

Self-funded group captive insurance offers risk-sharing benefits by allowing multiple employers to pool their resources and share the risks of healthcare claims. They essentially leverage the same risk benefits as a large corporation. Even a company with only 25 employees can enjoy a similar risk offset as a company the size of General Motors.

For example, each employer self-insures $25,000 of claims per member every policy period. Individual claims above $25,000, or an aggregate specific deductible for the group, claims are then paid out of the stop loss. Claims above $500,000 are paid by reinsurance to avoid the expense of catastrophic claims.

By self-insuring under a group captive, employers can benefit from greater purchasing power and lower administrative costs while still maintaining control over their healthcare benefits. This can be particularly beneficial for smaller employers who may not otherwise have the resources to manage their own self-funded plans.

Fixed vs. Variable Costs in a Self-Funded Health Insurance Plan

Self-funded group captive insurance offers a combination of fixed and variable costs, which enables employers to benefit from greater cost control and transparency. Unlike insurance carriers that offer fully insured plans with 100% fixed-rate structured health insurance, self-funded group captive insurance has fixed costs that are typically only around 15%.

This means employers are free to use cost containment strategies to lower the remaining 85% of their expenses, providing significant cost savings compared to traditional insurance models.

Return of Unspent Premiums in a Self-Funded Insurance Plan

Unlike traditional or level-funded insurance, self-funding gives you a return of unused premiums at the end of each year. These returned premiums are no-strings-attached, meaning you don’t have to sign a contract for the next year to receive them (as you might with a level-funded plan). Additionally, you will see 100% of your unused funds rather than the less than 50% that typically happens with level-funded insurance.

Flexible Plan Design in Self-Insurance

A significant benefit for businesses that self-fund is flexible plan design. With self-funding, you build your own plan from the ground up. This means you choose a Third Party Administrator (TPA), pass-through or transparent Pharmacy Benefits Manager (PBM), and cost-sharing structure that works for your company’s financial and coverage needs.

For example, you can design a plan with zero deductibles and low copays for certain services, such as primary or preventative care, to incentivize members to use the most cost-effective care.

You might also choose to add concierge services to your benefits plan to help your employees understand their benefits and use them in the most cost-effective way. The point is, you have options, and can design a plan that works for your members.

The Enhanced Data Transparency of a Self-Funded Insurance Plan

With a self-funded plan, you have transparent access to your claims data, unlike with traditional fully-funded insurance. Data transparency allows you to track where your funds are being used and identify high-dollar claims so you can implement strategies to reduce costs. All data is HIPAA-compliant.

Self-insurance also lets you see where you may need to add benefits for better member coverage, such as telehealth services, behavioral health providers, or chronic care management teams.

Cost Containing Opportunities Through Self-Insurance

Self-funded employer health insurance gives you multiple cost savings opportunities, starting with plan design. With self-funding, you design your plan to cut costs in the way you’d like that also benefits your employees, which means drafting a Summary Plan Description that meets your coverage and budgetary needs.

Once you implement your plan, you can use your claims data to enact cost containment solutions such as adding or changing providers, vendors, or PBMs to cut expenses and incentivize members to use cost-effective benefits.

Experience the Benefits of Self-Funded Insurance

If you’re ready to see increased savings on your company’s employee health insurance, consider switching to self-funded insurance with a group medical captive.

Speak to a Roundstone advisor today to learn how self-funding can help you cut costs and provide improved benefits to your employees.