Our practice

Employee benefits, starting with how the plan is funded.

We place and service the full range of arrangements, from fully insured through captives. Which one is right depends on your claims, your cash position, and how much variability you want to carry, and that is a conversation worth having properly.

Funding arrangements

Four arrangements, four different conversations.

Funding is not one product and it is not a ladder you are expected to climb on a schedule. Each arrangement places a different amount of risk with an insurance company or with you, and each one pays you back differently for what you take on. A smaller employer and a much larger one are in genuinely different conversations, and the right answer for each of them can be any of the four below.

Alternative funding is our specialty, and fully insured is a legitimate and often correct choice that we place and service with the same care. What follows is what each arrangement is, where it tends to fit, and what you trade for it.

Fully insured

Any size, and the right answer more often than the market suggests

What it is: You pay a fixed premium and the insurance company takes the risk. If your group has a heavy claims year, the carrier absorbs it, not you. Premium is set at renewal using your experience blended with pooled data, and your obligation for the year is the premium itself.
Where it fits: Employers who value certainty, groups whose claims are volatile or too small for their own experience to be credible, and organisations whose cash position makes a predictable monthly number genuinely valuable. It is also the sensible place to stay while you build the claims history that makes any other option worth evaluating.
The trade off: The premium includes a margin for the carrier, and that margin is the price of certainty. Certainty has real value, so this is a purchase rather than a concession. The part worth managing is visibility: fully insured carriers vary widely in what claims and utilization data they will release, and that data is what turns next year's renewal into a conversation instead of a notice.

Level funding

Smaller and mid sized groups, often the first step beyond fully insured

What it is: You pay a fixed monthly amount, the same way you would under a fully insured plan. Inside that amount sits a claims fund, an administrative fee, and stop loss premium. If claims come in under the funded amount, some or all of the surplus comes back to you. If claims run over, the stop loss carrier absorbs the excess and your fixed monthly payment does not change mid year.
Where it fits: A group with a reasonably stable claims history that wants to see its own data and has the discipline to reserve for a heavier year. The monthly cash flow feels familiar, which is why it is usually the first arrangement employers consider when they start asking what their plan actually costs.
The trade off: The surplus return is the headline, and the settlement terms are what decide whether it materialises. Some contracts return the surplus in full, some return a percentage, and some return nothing unless you renew. Underwriting also happens at entry and again at renewal, so a heavy claim year can change the arrangement you just moved into.

Self funding

Larger groups with credible claims experience

What it is: You pay claims as they are incurred, plus a fee to the administrator and stop loss premium to cap what any single claim or the aggregate year can cost you. There is no insurance company margin sitting on top of your claims dollars, and you keep every dollar you do not spend.
Where it fits: An employer with enough covered lives that claims experience is credible year over year, a balance sheet that can absorb a heavy month, and a real interest in managing cost rather than transferring it. At scale it is very often the lower cost structure.
The trade off: Cash flow is genuinely lumpier. You also take on plan sponsor responsibility, which means fiduciary duty, plan document maintenance, and compliance obligations that a fully insured carrier used to carry for you. The stop loss contract, not the funding label, determines how much risk you actually retained.

Group captives

Mid sized groups wanting the economics without carrying the volatility alone

What it is: A group of employers pools a layer of risk together in a shared insurance vehicle they collectively own. Each member keeps its own claims below the pooled layer and shares in the results of the layer above it. Underwriting profit that would have gone to a carrier stays inside the captive.
Where it fits: An employer who is not large enough for standalone self funding to be stable on its own, but wants the economics of it. Pooling smooths volatility, and captives tend to attract members who actively manage their plans, which matters because you share their results.
The trade off: It is a multi year commitment and exiting is not trivial. You are underwriting your fellow members as much as yourself, so the quality of the captive and the discipline of its membership matter more than the fee schedule. Collateral requirements are real and belong in the cash flow conversation up front.

How we approach it

We start from your data rather than from a preferred answer. Sometimes that points toward a funding change, and sometimes it confirms that your current arrangement is well built and the better opportunities are in plan design, pharmacy, or how the plan is communicated. Either way you finish the conversation knowing why, which is worth having on its own.

The rest of the practice

The work that continues once funding is settled.

Risk analysis

Reading claims and underwriting data to understand what is actually driving cost. Most renewal conversations happen at the level of a single percentage. Underneath that percentage are specific claimants, specific conditions, a pharmacy contract, a trend assumption, and a set of carrier judgments about credibility. Separating the part of your increase that is genuinely yours from the part that is caution is what turns a renewal into a negotiation.

Benefits education

Helping employees understand and use the plan. This is where a great deal of value is either created or quietly lost. An employer buys a strong plan, communicates it once at open enrollment in insurance vocabulary, and then watches people use the emergency room for things urgent care handles, skip preventive visits that cost them nothing, and fill brand drugs when a generic sits on a lower tier. Education is not a rebranded enrollment meeting. It is year round, in plain language, aimed at the handful of decisions that actually move claims.

Small and mid sized employers

This is deliberate, not a fallback. These employers are large enough that funding strategy meaningfully changes their cost, and they rarely have a benefits department to evaluate it. The person handling this is often a controller, an owner, or an HR generalist with several other jobs, and they deserve the same analytical work a much larger employer would receive.

The methodology

All of this runs through the Risk Analysis Plan.

Underwriting review, large claim review, stop loss audit, pharmacy benefit audit, and plan design analysis. Five components, run in order, that rebuild your renewal so you can see which assumptions produced it. It is the same work whether you stay fully insured or move into a captive, because it is what makes a funding decision an informed one.

The five components

Contact

Send us the renewal you are looking at.

Tell us the size of the group and what the carrier is asking for. We will come back with the questions worth putting to them, and a clear read of where your opportunities sit.

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