Health Insurance / Independent Benefits Brokerage
Year-One Savings Are Easy. Knowing If They Last Is Not.
Health insurance plans can look similar at enrollment and behave very differently when claims, renewals and contract terms are tested. BENEFITRA is the first brokerage to simulate all eight funding strategies over five years, best case and worst case, using medical underwriting and health condition probability and persistence logic so that you can know the amount and odds of savings across different solutions.
Educational overview. No savings estimate is generated on this page.
Eight funding structures
Who carries the claims risk?
The contract decides where uncertainty sits.
Fully insured, level funded, self funded and pooled arrangements distribute risk differently. The right comparison starts with the contract, not a fabricated savings estimate.
Our Most Advanced Analysis
Know Your 1- and 5-Year Savings and Odds in Two Clicks
Select Your State (Click One)
Click a state to preview its results ↓
Modeled examples, not quotes or guarantees. Actual results vary.
- Current state-adjusted market rates and consistent assumptions.
- 2,000 to 10,000 simulations with medical underwriting and health-condition persistence logic.
- Five modeled percentiles, not a hand-picked best case.
- Calibrated to published KFF, Milliman, AHRQ MEPS, and Society of Actuaries data.
The Problem Nobody Prices
A discount is not a strategy.
A lower opening price does not explain who carries risk, what data you receive, how renewal terms work or what it takes to leave the arrangement.
Every arrangement uses different contracts and responsibilities. A useful comparison makes those mechanics visible before any price or projection is treated as decision-ready.
Risk
Identify which party funds claims and where contractual limits apply.
Visibility
Confirm what plan and claims information the arrangement actually provides.
Renewal
Review the repricing basis, obligations and exit terms before comparing cost.
Decision Support
Eight ways to fund the same plan. They do not behave the same.
Select an arrangement to see who carries the risk, what you are allowed to see, and how it behaves the year after a bad claim. No arrangement is best for everyone — that is the reason to compare all eight qualitatively.
Selected path
Level-Funded
Fixed funding with defined claims and stop-loss terms
Path 02 of 08
Level-Funded
The funding agreement combines a scheduled monthly amount with claims funding and stop-loss protection. Contract terms govern reporting and any surplus treatment.
Educational comparison only. Availability, filing status and permitted structures vary by state and by group size.
The Structure Beneath the Plan
The carrier is what you see. The funding path does the work.
The workforce, network and benefits may look familiar while the ownership of risk, claims administration and renewal mechanics change underneath.
Each structure can be legitimate. The right fit depends on claims experience, cash-flow capacity, contract terms and the internal resources available to manage the plan.
Funding Arrangement
Defines who holds the risk, how claims are funded, how costs behave and which obligations apply at renewal and exit.
Provider Network
Determines provider access and negotiated terms. Network fit and disruption should be reviewed separately from funding.
Fully Insured note: the carrier generally bundles the TPA function and provider network together.
TPA
The administrator agreement governs claims administration, reporting, data access and service obligations.
Side by Side
The comparison your renewal packet leaves out
Add or remove arrangements to build the comparison you actually need. Every cell below is a structural property of the arrangement, not a sales claim.
| Dimension | 01Fully-Insured | 02Level-Funded | 03Self-Funded | 04Self-Funded Captive | 05MEWA | 06ICHRA | 07Taft-Hartley | 08PEO |
|---|---|---|---|---|---|---|---|---|
| Who holds the risk | Carrier. You pay a premium and the outcome is theirs. | Shared. Yours to the cap, carrier above it. | You. The employer funds claims under its own plan document. | You. Your captive owns the layer and the reserve. | The association pool. Risk mutualised across members. | Employees hold the premium risk. You fund a defined contribution. | The jointly trusteed fund. Risk sits with the trust. | The PEO's master plan. Pooled across all clients. |
| Your claims data | Typically, none. | Common. Should be confirmed. | Defined by the plan and administrator agreements. | High. Confirm frequency. | Defined by the association and plan documents. | Individual policies replace employer plan claims reporting. | Published annually at the plan level. | Defined by the PEO plan and service agreement. |
| Cash-flow shape | Fixed premium under the carrier contract. | Level monthly funding; surplus treatment depends on contract terms. | Claims funding, administration and stop-loss components. | Claims funding, administration and captive obligations. | Flat contribution, set by the pool. | Fixed by definition — you set the number. | Contribution rate set by the trust. | Single bundled invoice, hard to unpick. |
| Behaviour at renewal | Carrier renewal terms apply. | Group experience and carrier terms are reviewed. | Claims experience and stop-loss terms are reviewed. | Claims experience, reserves and stop-loss terms are reviewed. | Pool and association terms apply. | The employer reviews and sets its contribution. | Trust governance and bargaining terms apply. | Plan renewal is reviewed within the broader PEO agreement. |
| Eligibility and fit | Carrier rules and group details determine fit. | Carrier rules, group details and underwriting determine fit. | Underwriting, cash-flow capacity and plan governance determine fit. | Captive eligibility and underwriting determine fit. | Association eligibility and plan rules determine fit. | Workforce location and individual-market availability determine fit. | Employers in high-cost states or groups looking for renewal stability. | PEO eligibility and the service agreement determine fit. |
| Minimum Enrollment and Participation | 2+ enrolled; waivers count | 2+ enrolled; waivers count | 2+ enrolled; waivers count | 20+ enrolled; waivers count | 2+; waivers count | 100% of Eligible Employees | 5+ enrolled; 50% participation; waivers don’t count | 2+ enrolled; waivers don’t count |
| Exit friction | Review carrier termination and transition terms. | Review run-out and termination terms. | Review run-out, reserves and administrator obligations. | Review reserves, run-out and captive obligations. | Review membership and plan termination terms. | Review notice and plan-year transition requirements. | Once a year at renewal. | Review plan, payroll and service-transition obligations. |
Qualitative educational comparison only. Actual eligibility, reporting, funding and exit terms are contract-dependent and must be confirmed in plan documents.
How It Works
From plan documents to a defensible comparison
A responsible recommendation starts with the employer's actual plan information. No business-specific outcome is generated from generic assumptions.
Gather the source documents
Census, current plan documents, last renewal. If you have claims data we use it. If your current arrangement withholds it, we say so out loud — that is a finding, not a blocker.
Output: a clean baseline
Identify available structures
Eligibility, market availability, plan rules and underwriting determine which arrangements belong in the comparison.
Output: an eligible comparison set
Compare contracts and funding
Risk ownership, claims visibility, cash-flow mechanics, renewal terms and exit obligations are reviewed side by side.
Output: documented tradeoffs
Hand over the decision
The employer receives the comparison, the assumptions behind it and the items that still require carrier or underwriting confirmation.
Output: a decision record
Savings Levers
The levers that shape a health plan decision
These design levers can change cost, risk, administration and employee experience. Their effect must be evaluated from actual plan data.
01
Claims visibility
You cannot manage a spend you are not allowed to read. Detailed claims data can improve visibility into plan performance and support a more informed funding review.
Review data access and reporting terms
02
Stop-loss structure
Specific and aggregate attachment points, laser terms and contract basis. Where the ceiling sits decides whether one catastrophic claim rewrites your renewal.
Review attachment points and contract basis
03
Pharmacy carve-out
Carve-out terms, formulary design, rebates and administration can be evaluated separately from the medical arrangement.
Review pharmacy contract mechanics
04
Network steerage
Reference-based pricing, direct contracts or a narrow high-performance network, chosen against where your employees genuinely seek care.
Review access, disruption and contract terms
05
Captive layer participation
Participation can change risk sharing, governance, collateral requirements and exit obligations.
Review participation and governance terms
06
Contribution modelling
Tier design and employee cost share change enrolment mix, which changes risk. Contribution design can affect affordability, participation and enrollment mix.
Review affordability and enrollment effects
Client Results
Explore BENEFITRA's published case studies and client stories in their original context.
Verified Five-Year Simulator
Use BENEFITRA's live funding engine.
Below is a static preview of BENEFITRA's existing five-year Funding Simulator. The live tool cannot be embedded on this page, so the preview is shown for orientation only. Its calculations, assumptions and outputs come directly from the approved tool on benefitra.com, and this page does not recreate or approximate its business logic.
Verified workflow
Preview of the Live Tool
Health Plan Funding Simulator
A static preview of the five-year simulator as it appears on benefitra.com. The live tool cannot be embedded here; every input, comparison and projection is produced by BENEFITRA's approved engine on its own site.
benefitra.com/funding-simulator · static preview
Open the interactive version
Open Full Simulator
Static preview for orientation only. The interactive tool runs on benefitra.com.
This preview displays the existing state-page model outputs; it does not recalculate or generate new projections on this page.
Next Step
Bring us your renewal. We will compare the structure behind it.
Start with the current plan documents, census and available claims information. Any recommendation should follow the evidence, including when the current arrangement remains the right fit.