Group Health Insurance (Level-Funded)—also called group level funding—gives employers the cost control of fully insured plans with the transparency and potential premium refunds of self-funding. If your company wants predictable monthly costs, access to broad PPO networks, and the chance to get money back in good claim years, a level-funded plan can be a smart upgrade from traditional small-group insurance. For owners who also need succession or protection planning, see Key Person vs. Buy-Sell Life Insurance and Buy-Sell Life Insurance for Business.

Why Employers Choose Level-Funded Group Health

• Predictable Monthly Cost: One level payment bundles claims funding, admin, and stop-loss protection—easier budgeting than traditional renewals.
• Premium Refund Potential: If claims run favorably, employers may receive a year-end surplus refund (per carrier rules). Pair this with a company reserve or fixed annuity strategy to smooth future renewals.
• Small Groups Eligible: We work with groups down to 2 enrolled employees (varies by state/underwriter).
• 1099 Workers Accepted: Many programs allow 1099s if they meet plan eligibility—ask us about your state and carrier options.
• National Networks & Benefits: Broad PPO access, preventive care, virtual care, Rx programs, wellness incentives—designs vary.
• Transparency: De-identified utilization reporting helps you make data-driven changes. Owners concerned about key people should also review Key Person Insurance for Business.

How Level Funding Works

1. One Monthly Bill: You pay a fixed “level” amount that covers claims funding, administration, and stop-loss.
2. Claims Are Paid: The plan pays member claims from your claims fund; stop-loss caps large/unexpected claims.
3. Year-End Reconciliation: If claims are lower than projected, you may receive a refund or credit. If higher, stop-loss absorbs eligible excess per contract.

Who Is a Good Fit?

• 2–50+ employees seeking more control and potential refunds (subject to state rules).
• Groups with stable health trends or engagement in wellness/virtual care.
• Companies wanting to include 1099 contractors (eligibility varies—ask us).

Plan Design Highlights

• Networks: Broad PPO and EPO options. If leadership risk is concentrated, layer Key Person or Buy Sell coverage to protect revenue.
• Funding Options: Multiple “level” tiers to match budget; composite or age-banded rates available.
• HSA/HRA-Ready: Pair HDHPs with HSAs or integrate an HRA to offset member out-of-pocket.
• Rx Strategies: Formulary management, mail order, and specialty solutions reduce trend; align with Business Overhead Expense needs for owners.
• Virtual Care: Telemedicine, behavioral health, and chronic care coaching can reduce avoidable claims.

Underwriting & Implementation

• Simple Census: Provide a basic census (DOB/ZIP/dependent status). Some carriers require short health questionnaires; others may use alternative underwriting.
• 1099 Inclusion: Many level-funded programs allow 1099s—guidelines differ, so we’ll match you to a carrier that fits.
• Effective Dates & Admin: We coordinate enrollment, EDI feeds, and onboarding materials for a smooth start. Owners can simultaneously shore up continuity using Buy-Sell funding.
• Renewals: You’ll receive de-identified claims/utilization to support benefit and contribution decisions—plus any eligible surplus accounting.

Ways to Increase Refund Potential

• Promote Preventive Care: Physicals and screenings reduce avoidable high-cost claims.
• Virtual-First Access: Telemedicine and nurse lines for early intervention.
• Smart Rx Use: Generics, mail order, and adherence programs.
• Chronic Care Engagement: Diabetes/HTN coaching and remote monitoring.

Related Pages:

• Key Person vs. Buy-Sell Life Insurance
• Buy-Sell Life Insurance for Business
• Disability Business Overhead Expense
• Retirement Account Locator
• Current Annuity Rates
• Business & Life Insurance Services
• Why Work With Us (YouTube)