Group Health Plans · Fully insured & level-funded
Lower costs. Better coverage. A broker in your corner.
Not every company is ready to self-fund, and that is fine. We handle fully insured and level-funded group plans too — and we will find you the best option to increase benefits and cut what you spend on them.
Most of the companies that come to us are not badly insured. They are badly served: a renewal that lands in October with a double-digit increase and no explanation, an 800 number instead of an advisor, and nobody looking at the plan again until next year. That is the part we fix first.
Renewal negotiation
We take the increase apart line by line and go back to the market before you accept it.
Plan & carrier shopping
Independent, so we quote the whole market rather than the two carriers we are contracted with.
Dental, vision & ancillary
One advisor for medical, dental, vision, life and disability. One renewal conversation.
One point of contact
Renewals, plan changes, carrier escalations — one person who knows your plan, not a rotating account team.
What working with us actually looks like
The work most small groups never get.
Most companies that come to us are not badly insured. They are badly worked. The renewal arrives in October, the increase gets passed through, and nothing in between was ever tested. The difference here is not how quickly we answer the phone. It is how much actually gets done before your renewal lands on your desk.
01
We re-market your plan every year
Not just medical — dental, vision, life and disability too, which is where plans quietly auto-renew for a decade. Re-marketing takes real work and pays a broker the same as not bothering. That is exactly why most small groups never get it.
02
We take the renewal apart
A double-digit increase is a starting position, not a verdict. We ask for the underlying claims and trend assumptions, check the pooling and administrative loads, and go back to the carrier with data before we bring you a number to sign.
03
You see more than one number
Fully insured, level-funded, and — when your group is big enough for it to make sense — self-funded, priced side by side with the assumptions written down next to them. Most companies are only ever shown one option.
04
You deal with the person who did the work
No service pod, no rotating account rep, no junior who has never seen your plan. The person who quoted it is the person you call. And when your HR contact hits a wall with the carrier, that is where we step in.
And when the right answer is to stay exactly where you are, we will tell you that too.
Not a self-funding candidate
You can still stop overpaying.
Groups get ruled out for real reasons — fewer than about 25 employees on the plan, a claims history with a large open case, turnover that rewrites the census every year, or a contract you can't get out of mid-year. None of that means you have to accept the renewal you were handed.
Funding is one lever. It happens to be the biggest one, which is why the rest of this site spends so much time on it. There are six others we pull first — and on a fully insured plan, they're where the money is.
The renewal itself
We ask for the claims experience and trend assumptions behind the increase, check the pooling charge and the administrative load, and go back to the carrier with data. A double-digit increase is an opening position, not a verdict.
The whole market, every year
We're independent, so we quote every carrier willing to write your group instead of the two we happen to be appointed with. The same networks and the same doctors are often available at a materially different price.
Plan design and contributions
Deductible and coinsurance structure, a second plan option so employees can pick what fits their family, and a contribution strategy that lowers company spend without pushing cost onto the people least able to absorb it.
Pharmacy
Rx can run close to a third of total spend, and it usually gets reviewed as a footnote to the medical quote. Formulary tiers, copay structure, specialty handling and mail order deserve their own conversation — and their own negotiation.
HSA and HRA pairing
A higher-deductible plan with employer funding behind it often costs less in total than the richer plan it replaces, and employees can come out ahead — if it's built and communicated properly. That "if" is most of the work.
Eligibility and enrollment hygiene
Dependents who aged off, terminated employees still sitting on the invoice, hour tracking that doesn't match what the plan document actually says. Premium leaks quietly here, every single month, and nobody goes looking.
The middle option
Level-funded: most of the upside, none of the cash-flow surprise.
You pay a fixed amount every month, the way you do now. Underneath it, claims are paid out of your own funded account with stop-loss coverage sitting above it — so a heavy claims month never becomes a heavy cash-flow month. If the year runs better than expected, the unused claims funding can come back to you instead of staying with the carrier.
It's the natural first step for a group that's too small or too new to self-fund outright. You also start receiving claims reporting — the one thing a fully insured plan will never hand you — and that reporting is what makes a later move to self-funding provable rather than theoretical.
Refund provisions, reporting detail and availability vary by carrier and by state, and not every group will qualify. We'll show you the specific terms of any structure we put in front of you, in writing, before you decide anything.
Some of these will apply to you and some won't. That's what the review is for — we'd rather tell you three of the six are already handled than pretend all six are worth money on your plan.
Harder groups
The plans nobody wants to quote are the ones worth doing well.
Some workforces don't fit the shape a carrier's underwriting template expects. Those plans get quoted lazily, priced defensively and administered badly — which is exactly why there's room to do better on both the cost and the service. A few we spend real time on:
Large restaurant groups
Hourly and tipped staff, turnover that rewrites the census every year, several entities and locations under one owner, and variable-hour eligibility that has to be measured rather than assumed.
All of it is administrable. It just has to actually be administered — which means someone tracking hours against the plan document, not a spreadsheet rebuilt every October.
Entertainment and production companies
Project-based crews, headcount that swings with the slate, union and non-union populations sitting side by side, short engagements, and people moving on and off coverage mid-year.
The plan has to be designed for that pattern rather than patched around it every quarter. Eligibility rules and enrollment windows do most of the work here.
Part-time and variable-hour workforces
Measurement, administrative and stability periods, look-back testing, affordability, waivers, and documented offers of coverage for people whose hours move week to week.
Get it wrong and the exposure is penalties on top of premium. Get it right and you can often cover more of your people for less than you assumed.
This isn't a list of the only companies we work with. Plenty of our work is a straightforward professional services group with 90 people on the plan, and everything above applies there too — just more easily. It's a list of the situations other brokers would rather pass on.
And a group that looks hard on paper isn't automatically stuck fully insured. The same census that makes an underwriter cautious can make self-funding work well once someone sits down with the actual numbers. We'd rather find that out than assume it.
Group size
Fifty-one lives or five thousand. What changes is the leverage, not the attention.
Every one of these structures works — the question is which one your census can actually support this year, and what it would take to get you to the next one. Here is roughly how that plays out by size.
What comes into range, and when
Directional, not a rule. A 70-life group with clean claims can reach further than a 400-life group carrying a large ongoing case. The census decides it.
51–99
Employees
Small enough that a carrier prices you off a book, not off you
At this size the fully insured renewal is largely someone else's claims experience. Level-funded is usually the first real move — a fixed monthly cost that behaves like the premium you're used to, with claims reporting you've never had before and a refund provision if the year runs well.
It is also where a second, more affordable plan option alongside the main one can lift enrollment without lifting company spend.
100–499
Employees
Enough of your own history to be underwritten on your own numbers
This is where most of the real savings conversations happen. Your claims experience is credible enough to price against, and your headcount is large enough that one bad month doesn't decide the year. Full self-funding becomes a genuine option rather than a theory.
Stop-loss layering, plan design and contribution strategy start doing serious work here, and the pharmacy contract becomes worth negotiating on its own.
500–5,000
Employees
Now you have position — the question is whether anyone is using it
At this size you have leverage on the network discount, the pharmacy contract, the stop-loss terms and the administrative fee. The question stops being whether to self-fund and starts being how well the program is being run.
Multi-entity and multi-site structures, dedicated monthly reporting, and a service model that doesn't route your HR team into a national call center.
Under 50 lives, we'll tell you so. There are still ways to take money out of the renewal at that size, and they're above — but we're not going to sell you a structure your census can't carry.
Size is a starting point, not a verdict. A 70-life group with clean claims can end up with more flexibility than a 400-life group carrying a large ongoing case. The census is what decides it, and it takes about a week to find out.
Plan structures
Three ways to build the plan. Most companies only ever get shown one.
A benefits program is not one plan for everyone. It is usually a main plan that most of your headcount belongs on, plus something real for the people who currently waive coverage because they can't afford the main one. Those two decisions get made together, or they get made badly.
Qualified plans
Full major medical
ACA-compliant major medical in the familiar metallic tiers, on a PPO or EPO network, including high-deductible versions that pair with an HSA. This is what most of your employees expect and where most of your headcount should sit.
Deductible, coinsurance and out-of-pocket maximum are all design levers rather than fixed facts — which is exactly where a lot of unnecessary cost hides.
MEC-enhanced plans
The affordable middle
A long way above minimum and a step below full major medical: preventive care, primary care and specialist visits, labs and imaging, urgent care and emergency access, and first-tier prescriptions.
Built for the population that currently waives coverage entirely because the qualified plan costs more than they can carry. For a variable-hour or high-turnover workforce this is often the difference between a benefit and a formality.
MEC traditional plans
The compliance floor
Preventive services at the lowest cost per head, plus a prescription discount card. It satisfies the obligation to offer minimum essential coverage and nothing beyond that — and it is honest about being exactly that.
It also counts toward participation requirements, which is frequently what makes the richer plan viable for everybody else on the census.
Most of the groups we work with end up running two of these at once. The qualified plan carries the people who can afford it; the enhanced plan picks up the people who otherwise take nothing — and the blended cost per covered employee usually lands below where the single-plan version was heading.
Compliance
None of it matters if the filings are wrong.
Employer mandate
Offer tracking and documentation so the A and B penalty exposure stays theoretical.
Affordability testing
Contribution levels tested against the current safe harbors before open enrollment, not after.
1094 and 1095 reporting
Prepared, reconciled against payroll and filed on time.
SBCs, SPDs and wrap documents
Drafted, distributed and kept current as the plan changes.
Form 5500
Filed where required, with the schedules that actually apply to your plan.
COBRA and notices
Administered and distributed, including the ones nobody remembers until an audit.
This is not a separate product with a separate invoice. It is the part of the job that has to be right whether or not anyone thanks you for it — and it is the first thing that quietly stops happening when your account gets reassigned to a service pod.
Plan availability, benefit detail and network access vary by carrier, group size and state, and not every structure is available everywhere. We will show you the specific plan documents and the specific costs for your group, in writing, before you decide anything.
How we are paid
You should know what your broker makes on your renewal.
Most employers never ask, and most brokers never volunteer it. That is backwards. You are the one paying for it, so here is the whole arrangement in plain terms.
It is already in your rate
Broker commission is generally built into the premium a carrier quotes you — whether or not you actually have a broker working on your plan. Going without one does not usually save you the money. It just means nobody is doing the work.
It does not change where we place you
We are independent. No carrier owns us, and nobody upstream cares which one you land on. We do not get paid more for steering you somewhere — so the recommendation is just the recommendation.
Ask and we will show you
What we are paid on your plan, in writing, before you sign anything. If a flat fee makes more sense than commission for your situation, we will quote it that way instead.
A broker who will not tell you what they make on your renewal is telling you something.
Commission structures vary by carrier, state and product line. We will walk you through exactly how it works on your plan before you commit to anything.
Ancillary lines
One stop for all your benefits.
Most companies we meet have their medical with one broker, dental and vision with whoever quoted cheapest three years ago, and life and disability on autopilot since before the current HR director started. Nobody is looking at the whole package.
We place and service every line, which means one renewal calendar, one enrollment build, one point of contact for your employees, and real leverage when we take the package back to market.
Dental
PPO and DHMO options, network access your employees will actually use, and honest guidance on where a richer plan pays for itself versus where it does not.
Vision
Exam, frame and lens allowances priced against real utilization — usually one of the cheapest ways to make a benefits package feel meaningfully better.
Group life & AD&D
Basic and voluntary coverage, guaranteed-issue amounts, and a look at whether your current volume and rate structure still match your headcount.
Short & long-term disability
Income protection with definitions and elimination periods that fit how your workforce is actually paid, not a boilerplate template.
Voluntary & supplemental
Accident, critical illness and hospital indemnity — employee-paid options that soften a higher-deductible medical plan without adding to your budget.
HSA, FSA & COBRA
Account-based plan setup and administration, plus COBRA and continuation compliance handled so nothing falls through the cracks at termination.
One renewal conversation
Every line lands on the same calendar and gets reviewed in the same meeting, instead of four separate fire drills scattered across the year.
Leverage when we go to market
A carrier quoting your medical knows the dental, vision, life and disability are on the table too. That changes the number they come back with.
One number for employees
Your people should not have to figure out which carrier handles which card. They call us, and we sort out which line the question belongs to.
Fewer vendors, fewer renewals, fewer things landing on HR’s desk. One advisor accountable for all of it.
And when the numbers change
If self-funding ever becomes the right move, we will already have the data to prove it.
We are not going to push you into a funding change you are not ready for. Plenty of our clients should stay fully insured this year — the group is too small, the claims history is too volatile, or the timing is simply wrong.
But we do keep watching. Every year we are your broker, we build a clearer picture of how your plan actually performs — and the day the math tips in your favor, we bring you the numbers instead of a sales pitch.
01
We track your real claims
Even on a fully insured plan there are utilization reports, large-claim notices and pharmacy data worth reading. We read them, and we keep the history.
02
We model it both ways
Each renewal we run your group as fully insured, level-funded and self-funded side by side, so the comparison is grounded in your numbers rather than an industry average.
03
We tell you when to move
If self-funding would save you money without cutting a single benefit, you will hear it. If it would not, you will hear that too — in the same meeting.
Let us show you the math
Two minutes now. A straight answer in one business day.
Tell us how your plan is funded today, roughly how many employees are on it, and what your last renewal did. We will come back with where you stand and what we would look at first. No pitch, no obligation, no cost.
You will hear back from us within one business day — from a person, not an auto-responder.