Self-Funded & Fully Insured Plan Advisory

Structured evaluation and implementation support for employer health plan funding decisions in Richmond, VA.

Headquartered in Richmond, Virginia, we serve clients nationwide. 

When Funding Strategy Deserves Structured Evaluation

Health plan funding is not a one-size decision. Employers often remain fully insured by default, or consider self-funding without fully understanding the financial, regulatory, and administrative tradeoffs.

Choosing between fully insured and self-funded arrangements impacts cost volatility, cash flow, compliance obligations, and long-term benefits strategy.

As part of our broader Employee Benefits Consulting framework, we help employers evaluate funding options with clarity, documentation, and defensible analysis.

What Self-Funded and Fully Insured Advisory Means

Under a fully insured model, employers pay fixed premiums to a carrier, transferring claim risk to the insurance company.

Under a self-funded model, employers assume claim risk directly, often supported by stop-loss insurance to limit catastrophic exposure.

Each structure carries distinct implications for financial risk, regulatory oversight, reporting obligations, and plan flexibility.

Our role is not to promote one model over the other. It is to evaluate funding options based on workforce profile, claims data, cost structure, and long-term strategy — so decisions are made with tradeoffs clearly understood.

How Funding Strategy Connects to Long-Term Benefits Governance

Funding decisions should not occur in isolation. They influence renewal strategy, vendor negotiations, compliance obligations, and employee communication.

We integrate funding analysis into broader Group Medical Strategy planning, ensuring that plan design, network structure, and cost management align with organizational objectives.

Funding selection is not simply about premiums. It is about financial discipline, regulatory alignment, and sustainability.

Funding Analysis and Financial Modeling

We review claims history, contribution structure, workforce demographics, and risk tolerance to evaluate whether fully insured, self-funded, or level-funded arrangements are appropriate.

RFP and Carrier Evaluation

We coordinate and analyze carrier proposals to ensure comparable pricing, transparent assumptions, and defensible selection.

Stop-Loss and Risk Management Review

For employers considering self-funding, we assess stop-loss structure, attachment points, and risk mitigation alignment.

Implementation and Transition Support

We guide implementation timelines, vendor coordination, employee communication planning, and documentation alignment.

Ongoing Funding Oversight

Funding models require monitoring. We provide renewal strategy support and periodic evaluation to ensure continued alignment.