Which way should you fund your health plan?

Tell us a little about your group and see, in plain numbers, what each path is likely to cost — and where the real savings are. Hover any bar for the detail.

Employer size

State

Average age

Texas · small-group ≤50 → your 51-100 group is experience-rated

Your group is large enough that Fully-Insured is experience-rated — its premium already reflects your own claims, not a community-pool average. So Self-Funded vs Fully-Insured here is a question of cost and risk tolerance, not community-pool arbitrage.

See how much you may be overpaying →

Live simulation · your state's rules · five funding paths, five renewals deep

You're currently on

Your current premium Modeled — edit to make it yours

Your claims / loss experience Optional — sharpens self-funded

Paid claims or loss ratio anchors self-funded / level-funded to your own dollars. Blank ⇒ we use premium × 78%.

Enrolled employees

Your last renewal increase % (optional)

Fine-tune illustration assumptions ▸

Global assumptions (apply to all funding types)

Fine-tune a specific arrangement

PEO

Expected PEO renewal % Modeled — edit to make it yoursNational default 13%/yr — the mean of a right-skewed spread (95th ≈ 3×). PEOs serve members nationwide, so this is not state-specific.

Self-Funded / Level-Funded

Aggregate attachment from your stop-loss quote % (optional)State law typically sets the floor between 110 and 125 percent of expected claims.

Level-Funded surplus & corridor

Surplus-return % (good-year refund)

Surplus haircut / terminal-liability fee %Taken off the surplus before the refund (real: 5–6%).

Aggregate corridor % (of expected claims)Where aggregate stop-loss attaches. 120% market default; Trustmark 115% ASL is a valid lower pref; editable.

Surplus-return varies by carrier (a national carrier 50% · Trustmark 100% · Allstate selectable) — not 100% by default. Specific deductible & your own claims are set above; enter 0 as the specific for an aggregate-only book (e.g. Trustmark).

Traditional self-funded Rx rebate $/enrolled/yr

Stop-Loss Renewal Accuracy

Specific (individual) stop-loss deductible $Higher deductible ⇒ more leverage (fixed deductible vs rising severities). Blank ⇒ baseline.

Stop-loss renewal cap (%) (blank = none)Caps how much your stop-loss PREMIUM can rise at renewal — not your total cost. Your claims fund can still rise above this.

Laser cap (multiple of spec deductible, blank = uncapped)Bounds the per-claimant adverse-year contribution.

No-new-laser provision?

Yes

Self-Funded Captive

Captive reimbursement already included in your inputted rate?

Yes

Expected captive reimbursements Modeled — edit to make it yours

Estimated captive-layer premium $/yr

Expected distribution %

Captive Rx rebate $/enrolled/yr

Dividend is now based on the captive pool/risk-sharing premium, not aggregate stop-loss. Blank fields run on modeled defaults.

Stop-Loss Renewal Accuracy

Specific (individual) stop-loss deductible $Higher deductible ⇒ more leverage (fixed deductible vs rising severities). Blank ⇒ baseline.

Aggregate attachment from your stop-loss quote % (optional)State law typically sets the floor between 110 and 125 percent of expected claims.

Stop-loss renewal cap (%) (blank = none)Caps how much your stop-loss PREMIUM can rise at renewal — not your total cost. Your claims fund can still rise above this.

Laser cap (multiple of spec deductible, blank = uncapped)Bounds the per-claimant adverse-year contribution.

No-new-laser provision?

Yes

Quotes in hand? Set any path's price yourself — every chart, renewal and simulation recomputes on your numbers.

Starting cost

At renewal

2-year totals

5-year odds

iWhat this shows: the price to begin each way of paying for your health plan, side by side. Why it matters: the cheapest start isn’t always the best deal — the other tabs show what happens after year one.

What each path costs to start

Per employee / mo

Total / mo

Total / yr

Pricing basis

Conservative model

Our clients’ typical results

Level-funded ⇆ Self-funded

Level-funded

Self-funded

Taft-Hartley ⇆ MEWA

Taft-Hartley

MEWA

iWhat this shows: how each path’s price would change next year in a good, a bad, and a really bad (catastrophic) claims year. Why it matters: some paths barely move; others jump a lot. That gap is your risk if claims run high.

What happens next year

How each path's premium moves in a good, a bad, and a catastrophic claims year — side by side. Hover any bar for what's driving it.

iWhat this shows: Year 1 and Year 2 added together, under a good, bad, catastrophic, or one-big-claim year. Why it matters: one year can fool you. Two years together shows which path holds up when a bad year hits.

Two-year totals, four kinds of year

Per employee

Group / mo

Group total

Year 1 + Year 2 together under a good, bad, catastrophic, or big-claim year. Hover any bar for the year-by-year split.

iWhat this shows: we run thousands of pretend futures and count how often each path ends up cheapest, and by how much. Why it matters: it turns “it depends” into real odds — how likely you are to save, and how big a bad year could get.

Over five years, who comes out ahead?

Simulations Review over

How far ahead are you planning renewals?

Next 1–3 years

Full 5-year path

Best solution

Worst solution

Wins over current

Loses to current

Headcount growth

Enrolled by year Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 pick a growth rate above or type your own plan — every run follows this schedule

Odds of savings — how often each path comes out aheadThe share of simulated renewals in which each funding path finishes cheaper. Read it together with your amount of savings below — how often you win, and by how much.

Upload your census / claims for per-member accuracy?

Yes

Adjust the high-leverage assumptions behind the catastrophe engine — network discount, demographic mix, claims severity — or upload your census for exact, per-member accuracy. Off by default; every number above stays exactly as modeled.

Network-discount factor

commercial-billed → allowed0.70 (default 0.70)

% female

drives NICU / maternity50% (default 50)

% child dependents

pediatric drugs / gene therapy25% (default 25)

Claims severity / realization

scales all severity gates together1.00× (default 1.0×)

Average age override

Blank ⇒ uses the Average age selector above (default).

Upload your census precision mode

Load a member list and the engine uses each member's exact age and gender instead of the sliders above — the most accurate way to model your group's catastrophe risk (dependents included: they drive NICU, maternity and pediatric conditions).

Your census file is read in your browser and is not uploaded. Only group-level inputs, such as state, size and average age, are sent to our pricing server to run the simulation.

Supported format: CSV. Using Excel? In Excel choose File → Save As → CSV and upload that. Columns are auto-detected — date of birth (or age), gender/sex, and optionally relationship/tier (employee / spouse / child). Header names are flexible.

Upload your claims data precision input

The single most accurate input. Two optional files: (A) your aggregate paid-claims history anchors the group's claims level and trend, and (B) a high-cost claimant list lets the engine carry each ongoing claimant forward as a known case — so persistence in years 2–5 becomes fact, not just probability.

Claims data is protected health information. The file is read in your browser and is not uploaded. Only summaries are sent to our pricing server: average monthly claims, the trend, and for each large claimant the condition category, the dollar amount and whether the claim is ongoing. Names, birth dates and member IDs are not sent, and a file with a name column is rejected.

aggregate-claims template.csv high-cost-claimant template.csv

A · Aggregate paid claims

CSV with a period (month or year) and paid claims $ column; an optional enrolled (member count) column sharpens the PMPM. Header names are flexible; you can also paste CSV below.

B · High-cost claimants

CSV with annual $, condition/category and ongoing (Y/N) per claimant. Conditions map to the engine's buckets (cancer, dialysis, cardiac, transplant, NICU, MSK, specialty-Rx, autoimmune, other).

recalculating…

Talk it through with us

Which way should you fund your health plan?

What each path costs to start

What happens next year

Two-year totals, four kinds of year

Over five years, who comes out ahead?

Get your funding report

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Which way should you fund your health plan?

What each path costs to start

What happens next year

Two-year totals, four kinds of year

Over five years, who comes out ahead?

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