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Ohio Level-Funded vs Fully Insured:
Actuarial Analysis

Compare level-funded and fully insured health plan costs for your Ohio business. See potential savings, surplus refunds, and worst-case scenarios -- powered by Ohio-specific carrier data and actuarial benchmarks.

Ohio Level-Funded Market at a Glance

Avg FI Premium PEPM
$680/mo
LF Savings Potential
13% avg
Cost vs National Avg
-5%
LF Market
Very Competitive
Min Group Size: 2 employees
Surplus Return: 50-75% of unused claims fund
LF Carriers: UnitedHealthcare Level-Funded, Cigna Level-Funded, Aetna Funding Advantage, Medical Mutual Level-Funded
Mandates: ACA mandates plus autism coverage and mammography mandates
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Your Company
Tell us about your Ohio business so we can model level-funded vs fully insured costs using Ohio-specific rates and carrier data.
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Current Plan & Level-Funded Model
Enter your current fully insured costs and configure the level-funded model parameters. We'll show a side-by-side comparison using Ohio-specific data.
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Analyst Notes: Ohio Level-Funded Market

Actuarial Context: Ohio's cost index of 0.95 reflects the state's position relative to the national average for employer-sponsored health insurance. The level-funded discount potential of 13% is achievable for groups with favorable demographics, but actuarial credibility requires sufficient enrollment -- typically 2+ employees for most carriers in Ohio. Groups below this threshold face wider confidence intervals in claims projections, which carriers compensate for through higher stop-loss premiums and reduced surplus return percentages.

Methodology Disclosure: This calculator uses a simplified actuarial model that applies age factors (CMS 3:1 curve), industry adjustments (SOA experience studies), and state-specific cost indices (CMS GPCI) to the user's inputs. The stop-loss pricing is based on reference rate schedules from major reinsurers, adjusted by Ohio's stop-loss factor of 0.97. Actual carrier quotes will incorporate additional underwriting factors including census-level age/gender distribution, prior claims experience, SIC code, plan design details, and network selection.

Risk Assessment: The very competitive carrier market in Ohio provides strong competitive dynamics for level-funded pricing. Strong carrier competition provides good renewal leverage. Employers should request quotes from at least 3-4 carriers to ensure competitive terms on admin fees, stop-loss pricing, and surplus return provisions.

Level-Funded Health Insurance in Ohio: What Employers Need to Know

Ohio has one of the most competitive health insurance markets in the Midwest, with multiple regional and national carriers competing for business. The state's cost index of 0.95 is slightly below the national average, and Ohio's diverse economy includes employers across manufacturing, healthcare, technology, and professional services sectors. Level-funded plans are well-established in Ohio, with strong adoption among mid-size employers.

The Ohio market features both national carriers (UnitedHealthcare, Cigna, Aetna) and regional carriers (Medical Mutual, Anthem) in the level-funded space. Medical Mutual of Ohio has been particularly innovative in developing level-funded products tailored to the Ohio market. The Columbus, Cleveland, and Cincinnati metro areas all have robust carrier competition, providing Ohio employers with multiple options to compare.

Ohio's Department of Insurance treats level-funded plans as self-funded under ERISA and has maintained a stable regulatory environment. The state has moderate benefit mandates, including autism coverage and mammography screening requirements. Ohio's stop-loss market is competitive, with pricing running about 3% below national averages. The state's manufacturing heritage means many Ohio employers are familiar with self-funded concepts, reducing the educational barrier to level-funded adoption.

Frequently Asked Questions: Level-Funded Plans in Ohio

Is level-funded health insurance available in Ohio? +
Yes. Ohio employers have access to level-funded health plans from carriers including UnitedHealthcare Level-Funded, Cigna Level-Funded, Aetna Funding Advantage, Medical Mutual Level-Funded. The minimum group size is typically 2 employees. Level-funded plans in Ohio are treated as self-funded under ERISA, providing flexibility in plan design and potential savings.
How much can Ohio employers save with level-funded? +
Based on Ohio's average fully insured PEPM of $680 and typical level-funded discounts of 13%, employers can expect meaningful savings in the expected claims scenario. Best-case savings with surplus refunds can reach 20-30%, while worst-case exposure is capped by stop-loss insurance.
What happens if claims are higher than expected? +
Stop-loss insurance protects against catastrophic claims. Individual specific stop-loss covers any single claimant above the attachment point (e.g., $50,000). Aggregate stop-loss caps total group claims at 125% of expected. Your maximum exposure is predetermined and contractually limited.
What if claims are lower than expected? +
This is where level-funded shines. If your group's claims are below the funded amount, you receive a surplus refund. In Ohio, typical surplus return provisions are 50-75% of unused claims fund. With fully insured plans, the carrier keeps the difference.
Which Ohio employers are the best fit for level-funded? +
Level-funded plans work best for Ohio employers with 2-250 employees, younger-than-average workforces, and a desire for cost transparency. Industries with lower claims risk (technology, professional services, education) often see the best results. The Ohio market is classified as very competitive for level-funded options.

Built on Real Data -- Not Guesswork

This calculator uses Ohio-specific actuarial data, carrier rate filings, and published survey benchmarks.

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KFF Employer Survey

2025 benchmarks from 2,000+ employers on premiums, plan design, and funding type distribution

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SOA Claims Tables

Society of Actuaries group health experience studies for expected claims modeling by age and industry

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Stop-Loss Rate Data

Sun Life and Voya reference rate schedules for specific and aggregate stop-loss pricing by attachment point

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Ohio DOI Filings

State-level rate filings, carrier market share data, and regulatory requirements from Ohio's insurance department

Want a Custom Level-Funded Quote for Ohio?

Get a side-by-side comparison with actual carrier quotes from UnitedHealthcare Level-Funded, Cigna Level-Funded, Aetna Funding Advantage, Medical Mutual Level-Funded -- reviewed by a benefits advisor who knows the Ohio market.

Calculation Methodology

Fully Insured Cost: Current PEPM x number of employees x 12 months. Projected forward using the annual renewal increase rate.

Level-Funded Breakdown:
- Claims Fund: PEPM x claims ratio x state cost index (0.95 for Ohio) x age factor x industry adjustment x plan tier multiplier. This is held in a claims account to pay medical expenses.
- Admin Fee: PEPM x admin percentage. Covers TPA fees, network access, compliance, and reporting.
- Stop-Loss Premium: Based on attachment point selected. Adjusted by Ohio's stop-loss factor (0.97) and group demographics.
- Total Level-Funded: Claims Fund + Admin Fee + Stop-Loss Premium.

Scenario Modeling:
- Best Case: Actual claims at 55% of expected. Employer receives ~50% of surplus (unused claims fund) as a refund.
- Expected Case: Actual claims match the expected claims fund. Typical savings vs fully insured.
- Worst Case: Claims run 130% of expected, but stop-loss caps total exposure at 125% of expected claims fund.

State Cost Index: Ohio's index of 0.95 adjusts base claims for state-level provider costs, utilization patterns, and regulatory environment. Based on CMS Geographic Practice Cost Index and Ohio DOI rate filings.

Data Sources: SOA Group Health Experience Study, Mercer National Survey 2025, KFF 2025 Employer Health Benefits Survey, TrustMark/Voya level-funded reference data, Sun Life stop-loss rate manuals, NAIC stop-loss model regulations, CMS Federal Age Rating Curves, Ohio Department of Insurance filings.

© 2026 Benefitra. Estimates based on published survey data and actuarial benchmarks for Ohio. Actual level-funded pricing depends on carrier underwriting, census data, claims history, and plan design. This tool does not constitute an insurance quote. Ohio employers should consult with a licensed benefits advisor before making funding decisions.