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Health Plan Cost Projector

Fully insured, level funded, or self funded: what the projector shows

Most groups default to a fully insured renewal every year without testing the alternatives. This projector lets you compare the three main funding models side by side using your own census and spend, so the choice is grounded in numbers rather than habit.

The right model usually tracks with size and claims stability. Fully insured tends to fit smaller or higher risk groups that want zero volatility. Level funding often becomes attractive once a group has roughly 25 or more enrolled employees and a reasonably healthy population. Self funding gives the most control and upside for larger or healthier groups, with stop loss insurance protecting against a bad claims year.

Once you have a funding direction, run a Premium Renewal Stress Test to see how each model holds up in a worst case year, or review your small business health plan options for context on coverage design.

What the projector compares:

National benchmarks for employer premiums and funding trends are tracked in the KFF Employer Health Benefits Survey.

Frequently asked questions

When does level funding start to make sense?

As a rough guide, groups with about 25 or more enrolled employees and stable claims often see level funding pencil out, because the carrier can price the risk and return unused claims funds. Below that, fully insured is frequently the safer call.

What is stop loss and why does it matter?

Stop loss is insurance that caps your exposure on a self funded plan. Specific stop loss limits any one member's claims; aggregate stop loss limits total claims for the year. It is what lets a mid-size employer self fund without betting the budget on a healthy year.

Will my costs actually drop if I change funding models?

Sometimes, and sometimes the gain is stability rather than a lower headline number. Projecting all three models on your own data is the only reliable way to know.

Reviewed by Sam Newland, CFP, Founder of Benefitra. Last updated June 2026.