Everything You Need to Know About Level Funded Health Plans

Friday, May 5, 2023 19:26 Posted by Admin

Are you a business owner overwhelmed by the rising costs of employee health insurance? Have you ever wondered if there’s a way to take control of these costs while still providing excellent health benefits to your team, including mental health coverage? What if we told you there is a solution that allows you to potentially save money while ensuring your financial risk is well managed? Welcome to the world of level funding.

Here at Taylor Benefits Insurance Agency, we understand the challenges businesses face when it comes to healthcare coverage. A traditional fully insured plan often comes with high costs and limited flexibility. On the other hand, self-funded plans can seem daunting due to the risk of high claims. But what if there was a middle ground?

Level funded plans offer a balance between these two extremes. They provide cost predictability, flexibility, and the potential to save money if your claims are lower than expected. Furthermore, they come with stop loss coverage to protect you from high claims, ensuring your financial risk is well managed.

In this article, we will dive deep into level funded plans, exploring their benefits, how they work, and why they could be the perfect solution for your business. We’ll explore how these plans allow you to pay claims directly, potentially saving money if the actual claims are lower than expected. Plus, you’ll learn about the potential to get a refund of unused claims dollars at the end of the year, a feature unique to level funding.

Stay with us as we guide you through the ins and outs of level-funded plans, helping you make an informed decision for your business healthcare strategy.

Understanding a Level Funding

At the heart of the matter, level-funded plans are an innovative approach to managing healthcare costs for businesses. As a hybrid solution, these plans bridge the gap between the traditional fully insured plans and the self-funded health plan model, providing the best of both worlds.

The primary feature that differentiates level-funded plans from other health coverage is the payment structure. With level-funded health plans, the employer pays a fixed, level (or equal) amount each month. This monthly payment is calculated based on an estimate of the company’s healthcare costs for the year.

To comprehend this better, it’s useful to contrast level funded health plans with self-funded health plans. A self-funded health plan is one where the employer assumes the financial risk for providing health care benefits to its employees. In self-funding health care, employers decide to pay for health care out of pocket as needed, instead of paying a fixed premium to an insurance carrier.

Level funded plans take the concept of self funding and add an extra layer of financial protection. This protection comes in the form of stop-loss insurance, which is included in the fixed monthly payment. Stop-loss insurance safeguards the business from the risk of unexpectedly high health care costs, which can pose a significant financial burden.

A third party administrator plays a crucial role in level funded health plans. The third party administrator is responsible for processing the health care claims. In addition, they provide the employer with detailed reports on health care use, which can help businesses better understand their health care costs and make more informed decisions.

In a nutshell, level funded health plans offer a unique combination of cost predictability, potential savings, and financial protection. By allowing the employer to pay only for the actual healthcare costs incurred, while also providing the safety net of stop-loss insurance, level funded health plans represent an effective and flexible solution for managing health care expenses.

How a Level Funded Plan Works

level funded health plans

Understanding the mechanics of level funded plans can give businesses a clear view of how these plans can be a practical alternative to traditional health insurance. Level funding is a concept that combines elements of both fully insured and self funded plans, offering a balance between cost predictability and potential savings.

Step 1: Determining the Fixed Monthly Payment

At the onset of a level funded plan, the insurance company and the employer agree on a fixed monthly payment. This payment is determined based on several factors, including the size of the business, the health status of the employees, and historical health care costs. The goal is to estimate the amount that the business will likely spend on health care over the course of the year.

Step 2: Payment Distribution

This fixed monthly payment is then divided into three main parts:

1. Administrative costs: These are the costs associated with managing the plan. They often include fees paid to a third-party administrator who processes the claims.

2. Stop-loss insurance premium: This part of the payment goes towards purchasing stop-loss insurance. This type of insurance provides financial protection against unexpectedly high health care costs.

3. Claims fund: The remainder of the payment is put into a fund to pay for the actual health care claims incurred by the employees.

Step 3: Managing the Financial Risk

A key feature of level funding is how it manages the financial risk associated with health care. Unlike a traditional self funded plan, where the employer bears the full risk of higher-than-expected health care costs, in level funded plans, this risk is mitigated by stop-loss insurance.

If the actual health care costs exceed the amount in the claims fund, the stop-loss insurance kicks in to cover the additional costs. This arrangement provides the employer with a safety net, protecting them from the financial risk of unexpectedly high claims.

Step 4: Potential for Refunds

One of the unique advantages of level funded plans is the potential for a refund at the end of the year. If the actual health care costs are lower than anticipated and there’s money left in the claims fund, the employer may receive a refund. This feature provides an additional financial incentive for businesses to promote a healthy workforce.

In essence, level funded plans offer businesses a smart way to manage their health care costs. They offer the cost predictability of fully insured plans, the potential savings of self-funded plans, and the added financial protection of stop-loss insurance.

Benefits of Level Funded Health Plans

There are several compelling reasons to consider a Level Funded Health Plan for your business.

Cost Efficiency

One of the primary benefits is cost efficiency. Because employers only pay for the actual healthcare costs incurred, they have the potential to save money if their employees are healthier than average.


These plans also offer greater flexibility. Unlike traditional insurance plans, Level Funded Health Plans can be tailored to fit the unique needs of your business.


With Level Funded Health Plans, employers have more transparency into their healthcare costs. They receive detailed reports on healthcare usage and costs, enabling them to make more informed decisions.

Who Can Benefit From Level Funded Health Plans?

Generally, Level Funded Health Plans are best suited for small to medium-sized businesses that have a relatively healthy workforce. These businesses can leverage the cost-saving potential of these plans, while the stop-loss insurance provides protection against unexpectedly high claims.

Comparing Level Funded Health Plans to Traditional Plans

When assessing the value proposition of level funding, it’s beneficial to compare it to traditional health insurance plans. There are several key differences that make level funded health plans an appealing option for certain businesses.

Predictability of Health Insurance Costs

Traditional health insurance plans usually come with fixed premiums, offering predictability in terms of health insurance costs. However, they don’t offer much flexibility and often result in businesses paying for more coverage than they need.

With level funding insurance, businesses pay a fixed monthly amount too, but this amount is based on expected claims, offering potential cost savings if the actual claims are lower than expected.

Management of High Claims

In a traditional fully-insured health insurance plan, the insurance company bears the risk of higher than expected claims. However, businesses pay a premium for this risk protection in the form of higher insurance costs. On the other hand, level funding insurance provides a safety net against high claims through stop-loss insurance, and businesses only pay for the actual claims up to a certain limit.

Flexibility and Control

Traditional plans offer less control over the plan design and benefits. Self insured health plans, including level funded plans, provide businesses with more flexibility to tailor their health plan to fit their specific needs. They can choose to include various features like employee wellness programs to promote a healthier workforce, which can further lower their health care costs.


Level funding also offers more transparency compared to traditional plans. Businesses receive detailed reports about their health care usage and costs, which can provide valuable insights for managing their health care strategy. In contrast, traditional plans often don’t provide this level of detail, making it harder for businesses to understand and control their health care costs.

While traditional health insurance plans offer simplicity and risk protection, they often come with higher costs and less control. Level funded health plans offer a compelling alternative, combining the cost predictability of fully insured plans with the flexibility, potential savings, and transparency of self funded health plans. They represent a middle ground, offering businesses a more tailored and potentially cost-effective solution for managing their health care costs.

How to Implement a Level Funded Health Plan

Implementing a Level Funded Health Plan requires careful planning and consideration. Businesses should consider their workforce’s health, anticipated healthcare costs, and their ability to manage the plan. It’s also wise to work with an experienced health benefits consultant to navigate this process.

Common Misconceptions About Level Funded Health Plans

Some people may believe that Level Funded Health Plans are too risky or complicated. However, with stop-loss insurance and professional guidance, these risks can be effectively managed. Furthermore, the potential cost savings and benefits often outweigh the challenges.

The Future of Level Funded Health Plans

As healthcare costs continue to rise, a level funded plan is likely to become increasingly popular since they offer a promising solution for businesses looking to take control of their healthcare expenses while still providing quality care for their employees.


Level Funded Health Plans represent an innovative approach to healthcare coverage. They offer a balance of cost efficiency, flexibility, and transparency, making them an attractive option for many businesses. As with any significant business decision, it’s important to understand the pros and cons and seek professional advice to ensure it’s the right fit for your organization.

As healthcare continues to evolve, level funding is poised to play an increasingly important role in shaping the future of business healthcare strategies. Don’t hesitate to contact our experts to learn more about level funding for small businesses.

Written by Todd Taylor

Todd Taylor

Todd Taylor oversees most of the marketing and client administration for the agency with help of an incredible team. Todd is a seasoned benefits insurance broker with over 35 years of industry experience. As the Founder and CEO of Taylor Benefits Insurance Agency, Inc., he provides strategic consultations and high-quality support to ensure his clients’ competitive position in the market.

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