Year-One Savings Are Easy. Knowing If They Last Is Not.

The page compares fully-insured, level-funded, self-funded, self-funded captive, MEWA, ICHRA, Taft-Hartley and PEO arrangements. For each one it shows who holds the risk, what claims data you receive, how cash flow behaves, what happens at renewal, who can join and how hard it is to exit. The comparison is qualitative and educational, and no arrangement is best for everyone.

The simulator models eight funding strategies over five years in a best case and a worst case. The page says it runs 2,000 to 10,000 simulations using medical underwriting and assumptions about how likely health conditions are and how long they last. Results are shown as the 5th, 25th, 50th, 75th and 95th percentiles, not a hand-picked best case. They are modeled examples, not quotes or guarantees.

The savings figure on this page is not a quote. This page generates no savings estimate and says so. The state previews display existing state-page model outputs and are labeled as modeled examples, not quotes or guarantees. Final rates and plan designs depend on underwriting, carrier appetite and your census. To get firm numbers, use the live funding simulator for modeled odds and request a quote for actual pricing.

The page states that the model uses current state-adjusted market rates with consistent assumptions, and is calibrated to published KFF, Milliman, AHRQ MEPS and Society of Actuaries data. It also notes that a Blackwell underwriter reviewed the model's renewal methodology and its use of relative default assumptions for illustrative comparisons. Actual rates may vary, so treat outputs as illustrations of how each structure behaves.

Bring your census, current plan documents and your last renewal. If you have claims data, it is used. If your current arrangement withholds claims data, that is reported as a finding rather than a blocker. The result is a comparison, the assumptions behind it and a list of items that still need carrier or underwriting confirmation before any decision.

The page asks you to review four things before comparing cost: which party funds claims and where contractual limits apply, what plan and claims information you actually receive, how renewal is repriced, and what termination, run-out and transition terms apply. The side-by-side table gives a starting description of each arrangement, but actual terms depend on the contract and plan documents.

The table lists, for example, 2 or more enrolled with waivers counting for fully-insured, level-funded and self-funded plans, 20 or more for a captive, 5 or more enrolled with 50 percent participation for Taft-Hartley, 2 or more with waivers not counting for a PEO, and 100 percent of eligible employees for ICHRA. These are structural summaries, so confirm them in the plan documents for your state and group.

The page lists six levers: claims visibility, stop-loss structure, pharmacy carve-out, network steerage, captive layer participation and contribution modeling. Each can change cost, risk, administration and employee experience, and each must be evaluated from actual plan data. For each lever the page points to what to review, such as attachment points, contract basis, access and disruption, or affordability and enrollment effects.