EVEN IF YOU DON'T QUALIFY
There Are Still Better Options
The risk assessment still provides valuable insight.
Even when employers do not qualify for the three-year program, other strategies may still improve cost control and transparency including:
Level Funded Plans
Best for growing employers seeking predictable costs. If claims are lower than expected, employer could see surplus refund.
ICHRA Contribution Strategy
Best for smaller or geographically distributed workforces and particularly effective for organizations with variable workforce sizes.
Optimized Fully Insured Models
Improve your traditional insurance plans through better carrier negotiation, plan design adjustments, and cost-management tools.
Claims Indemnification Options
Reduce healthcare costs by identifying and correcting inefficiencies within medical claims by adding auditing claims software.
Captive Participation Strategy
Best for employers seeking long-term stability and shared risk. Captives are often used by employers who want multi-year healthcare funding stability.
Alternative Plan Design Models
Restructure benefits to better align costs with employee utilization and employer goals to improve cost control and increase transparency.
Our goal is always the same:
Align healthcare funding with the employer’s risk profile.
Understanding Health Plan Risk
Employer health plans fall across a risk spectrum:
RISK TRANSFER
Insurance carrier absorbs the risk
RISK SHARING
Employer and carrier share risk
RISK RETENTION
Employer assumes risk with protection from catastrophic claims
Each funding strategy fits somewhere within this spectrum.
Your organization’s size, claims history, and risk tolerance determine which structure is appropriate.
ICHRA
(Individual Coverage Health Reimbursement Arrangement)
Best for: smaller or geographically distributed workforces.
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ICHRA allows employers to reimburse employees for individual health insurance using tax-advantaged contributions.
Benefits include:
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• predictable employer budgets
• expanded employee choice
• simplified administration
ICHRA is particularly effective for organizations with remote employees or variable workforce sizes.
Captive Arrangements
Best for: employers seeking long-term stability and shared risk.
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Captive arrangements allow multiple employers to participate in a structured risk pool.
Advantages may include:
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• improved underwriting leverage
• reduced volatility
• potential participation in underwriting profits
Captives are often used by employers who want multi-year healthcare funding stability.
Traditional Self-Funded
Best for: mid-size and large employers seeking long-term cost control.
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In a self-funded model, the employer pays healthcare claims directly rather than paying fixed premiums to a carrier.
Stop-loss insurance protects the employer from catastrophic claims exposure.
Advantages:
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• full claims transparency
• customizable plan design
• long-term cost optimization
• ability to capture underwriting gains
Self-funding allows employers to move beyond the annual renewal cycle and manage healthcare costs strategically.
Level-Funded
Best for: growing employers seeking predictable costs with potential savings.
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Level-funded plans combine elements of fully insured and self-funded models.
Employers pay a fixed monthly amount that covers:
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expected claims
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administrative costs
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stop-loss protection
If claims are lower than expected, the employer may receive a surplus refund.