Health benefits that cost less and cover more.
Self-funding isn’t exotic — most large employers already do it. Instead of paying a carrier a fixed premium and letting them keep whatever’s left over, your company pays for the healthcare your employees actually use, plus transparent fixed costs. Same ID cards, same networks, same experience for your people — often with richer benefits.
Protected on the downside. Yours on the upside. Stop-loss insurance puts a hard ceiling on what you can pay — per person and for the year in total — so a bad claims year can’t hurt you. And in good years, the unspent money stays in your account instead of becoming carrier profit.
The math behind the savings
Where does the premium dollar go?
A fully insured premium isn't priced to your expected claims. It's priced well above them — and the gap is the carrier's margin, not your employees' care.
Fully insured
The amber slice is the risk corridor. The carrier keeps it.
It's priced into your premium either way. Run at or below expected claims and the difference never comes back — every year, with no reporting to you.
Self-funded
Same slice, same protection. You keep it if the year runs at expected.
You fund the corridor instead of buying it. Spend it only if claims run high — otherwise it stays in your account.
Where your dollar goes when you self-fund
The risk corridor
Same slice of the dollar. Two very different destinations.
Carriers don't underwrite a fully insured plan to what they expect your claims to be. They underwrite it to cover claims well above expected — on the order of 125%. That cushion is the margin the carrier is underwriting to earn, and it's built into your premium whether your employees ever use it or not. Self-funded, you set the same money aside for the same protection. The only thing that changes is whose account it's sitting in when the year comes in at expected.
Claims funding, self-funded
100% of expected125%
The corridor runs about 20% of your claims dollars — roughly 14% of total plan cost. Fully insured, you pay it and it's gone. Self-funded, an at-expected year hands it back.
Run at expected and the corridor is your savings — not the carrier's earnings.
Illustrative allocation of a self-funded plan's total cost; percentages are rounded and shown to explain the funding model, not to quote your plan. Your actual mix depends on plan design, census, stop-loss attachment point, and claims experience. Companies moving from fully insured typically save 15–30%, with the same networks and the same experience for employees.
Not experimental
Most large employers already fund their own plans.
Self-funding isn't a workaround or a loophole. Above a certain size it is simply how companies buy healthcare — because the math stops favoring the carrier and starts favoring the employer.
Adoption figures reflect published employer benefits survey data (KFF Employer Health Benefits Survey). Savings range is typical for groups we evaluate and is not a guarantee.
Where the savings come from
We cut out the carrier’s margin — and you keep the profit.
Health benefits are likely one of your three largest line items. It is also the one almost nobody audits. Every dollar you stop overpaying lands directly on your bottom line — not on a carrier’s earnings report.
Four places the money is hiding
- Underwriting marginFully insured premium is priced with a risk cushion built in. If your people stay healthy, the carrier keeps the cushion.
- Administrative loadBundled, undisclosed, and non-negotiable. Unbundled, the same services cost less and you can see the price.
- Pooling chargesYou subsidize the carrier’s entire book of business. Self-funded, you pay for your own risk — and only your own.
- Pharmacy rebatesRebates negotiated on your employees’ prescriptions are kept by the carrier. They should be yours.
15–30%+ savings,
straight to the bottom line.
These are not soft savings or projected efficiencies. They are dollars that stop leaving the company. There is no benefit reduction attached to them.
Don’t hand the profits and the rebates to the insurance carrier.
In your own plan, unspent claims dollars stay in your account and pharmacy rebates come back to you. Both are yours because the plan is yours.
Transparency
We hand you the transparency to see where every healthcare dollar goes.
A fully insured carrier has no obligation to show you much of anything. You get a renewal number and a reason. In your own plan, the data is yours — which is the only way a benefits decision can actually be made on evidence.
Fully insured
The black box
- Little or no claims detail — often nothing below aggregate
- Renewal increases arrive as a number, not an explanation
- Administrative fees bundled into premium and never itemized
- Pharmacy rebates negotiated on your plan, disclosed to no one
- No way to test whether a plan change would actually help
Self-funded with Zoe Group
The open book
- Monthly claims reporting — utilization, high-cost drivers, trend
- Every fixed cost itemized and quoted separately
- Rebates disclosed and returned to your plan
- Plan changes modeled against your own data before you commit
- Renewals you can question, because you can see the inputs
The safety net
Protected on the downside. Yours on the upside.
The first question every CFO asks is the right one: what happens in a bad year? Self-funding does not mean absorbing unlimited risk. Stop-loss insurance sets a hard ceiling on what your plan can cost — the same ceiling logic a carrier uses internally, except you own the upside instead of them.
Layer one
Specific stop-loss
Caps what any single employee’s claims can cost your plan. One catastrophic case does not become your problem — above the threshold, the stop-loss carrier pays.
Layer two
Aggregate stop-loss
Caps what all claims combined can cost you for the year. Your worst-case total is a number you know before the plan year starts.
Layer three
Your maximum liability
Fixed costs plus the aggregate cap equal your true worst case — and it is typically close to what you were already paying fully insured.
The asymmetry is the whole point.
Fully insured, a good claims year benefits the carrier. Self-funded with stop-loss in place, a bad year is capped and a good year is yours. That is not a trade-off — it is a better position on both ends.
- Bad year: your cost stops at the aggregate cap, near what fully insured would have cost anyway.
- Average year: you save the carrier’s margin, administrative load, and pooling charge.
- Good year: unspent claims dollars stay in your account instead of the carrier’s.
What's underneath
Self-funded does not mean self-serve.
The most common objection we hear is that self-funding sounds like taking the insurance company's job in-house. It isn't. The networks, the carriers and the administration are all still there — they are simply assembled so the margin lands on your side of the ledger instead of theirs.
A-rated
Stop-loss placed with financially rated carriers, not a promise on a spreadsheet
860,000+
Contracted providers available on a national PPO network
6,200+
Hospitals in that same national network footprint
65,000+
Participating pharmacies through a national pharmacy network
The catastrophic layer is insured. It always was.
You are not writing an open cheque. Individual stop-loss caps what any one claimant can cost the plan, and aggregate stop-loss caps what the whole population can cost across the year.
Both numbers are agreed before the plan year starts, and both sit with rated carriers. Your worst case is a number you approved in advance — which is more than a fully insured renewal ever tells you.
The same doctors, the same hospitals
Self-funded plans are built on established national PPO networks — in most cases the same contracted providers and facilities your employees are already using, at negotiated rates rather than list price.
Nobody has to change doctors to save the company money. Before anything moves, we run your key providers and facilities against the specific network your plan would use and show you the result.
Pharmacy stops being a footnote
Prescriptions run through a national pharmacy benefit manager with tens of thousands of participating pharmacies, with the formulary, the tiering and the rebate arrangement disclosed to you rather than buried in a bundled rate.
Rebates belong to the plan — which is to say, to you. On a fully insured contract they belong to the carrier, and you will never see the number.
Somebody else still does the administration
Eligibility, claims adjudication, ID cards, member service, pre-certification and monthly reporting are run by an established third-party administrator. Your HR team's day does not get harder; in our experience it gets easier, because there is finally somewhere to call.
The difference is the reporting. Every month you see what was spent and on what — the one thing a fully insured carrier will never hand you.
You are not buying a leap of faith. You are buying the same care, delivered through the same networks, with the underwriting margin and the rebates redirected to your bottom line instead of an insurer's.
And every party gets named. Stop-loss carrier, network, pharmacy manager, administrator, and every fee each one charges — in writing, before you sign anything. If a broker will not put that list in front of you, that is the answer to a different question.
Network, pharmacy and administrative arrangements vary by group, plan design and state, and provider and pharmacy counts reflect the national network footprint rather than a guarantee of availability in every market. We confirm the specific network, carriers and fees that apply to your group in writing before implementation.
Member experience
A plan is only as good as the morning somebody actually has to use it.
Your employees do not evaluate their benefits by reading the summary of benefits and coverage. They evaluate them the first time they need an ID card at a pharmacy counter, or a straight answer about whether something is covered. When we build a self-funded plan, that is a large part of what we are choosing the administrator for.
A member concierge, 24/7
A live person for eligibility questions, benefit questions, billing confusion and the calls that would otherwise land on your HR manager at 4:50 on a Friday. Available around the clock, including to the third-shift employee who cannot call during business hours.
Telemedicine at no cost
Included in the plan rather than sold as an upgrade, 24 hours a day. It is the single cheapest way to keep a sore throat out of an emergency room — which matters to the employee's evening and to the plan's claims run alike.
ID cards without the wait
Digital cards available immediately in the member portal, printable on the spot, so a new hire is not standing at a pharmacy counter in week one explaining that the mail has not arrived yet.
Provider search that reflects the real network
Search by name, specialty or location against the network your plan is actually built on. We confirm your key providers and facilities before anything changes, not after somebody discovers their pediatrician is out of network.
Claims, EOBs and balances in one place
Deductible, copays, coinsurance and out-of-pocket progress visible at any time, alongside claim status and explanations of benefits. Employees stop guessing, and HR stops relaying.
Pre-certification and imaging handled up front
Prior authorization for procedures and prescriptions is managed before the appointment instead of disputed after it, and advanced imaging — MRI, CT, PET — can be steered to high-quality facilities at a materially lower cost to both the member and the plan.
And when it still goes wrong, that call comes to us. A denied claim, a surprise balance bill, a prior authorization that stalled, a spouse who was added late. Your employees get a person who calls them back, and your HR team gets its week back.
This is the part nobody quotes on. Two plans can carry an identical benefit schedule and produce completely different years, and the difference is almost always who picks up the phone. It is also the easiest thing for us to be measured on.
Specific member services, portal features and network access vary by plan design, administrator and state. We will confirm exactly what is included for your group before you decide anything.
Line by line
Same benefits. Better strategy. Lower total cost.
Your employees should not be able to tell the difference — same doctors, same network, same cards in their wallets. Everything that changes happens on the finance side of the plan.
| Fully insured | Self-funded with Zoe Group | |
|---|---|---|
| Where unspent premium goes | The carrier keeps it | Stays in your account |
| How it is priced | Underwritten with about 26¢ of carrier spread built in | You pay actual claims plus fixed costs |
| Claims data | Little to no visibility | Full transparency — you see every dollar |
| Rx rebates | The carrier keeps them | Returned to you |
| Plan design | The carrier’s standard menu | Built for your workforce |
| Renewals | A black-box increase | Data-driven and negotiable |
| Risk exposure | Priced into premium — you pay for it either way | Capped by stop-loss coverage |
| Employee experience | Same network, same cards | Same network, same cards — often richer coverage |
| Support | An 800 number | A named advisor who answers |
Comparison reflects the structural differences between fully insured and self-funded arrangements. Specific results depend on your group’s size, claims history, and plan design.
The math
Five years, side by side.
This is what the decision actually looks like on a P&L. The bars are what a self-funded plan cost this company year by year, broken into the three parts it’s actually made of. The amber line is the most it could have cost — the maximum liability, if claims had run all the way up to the stop-loss attachment point. The dashed line is the fully insured renewal path they walked away from: the same 8% annual increase most groups are quietly absorbing. Even at the ceiling, self-funded came in under the premium in all five years.
$1.12M
Saved in year one alone — same network, same doctors, same coverage.
$7.9M
Kept over five years instead of handed to a carrier as premium.
$4.6M
Still saved across five years even if claims had hit the ceiling every single year.
Zero
Changes to employee networks, physicians, or member ID cards.
The best case is money you never spent. The worst case was still cheaper than the guarantee.
All figures in $ thousands
| Year | Admin | Stop-loss | Claims paid | Self-funded total | Max liability | Fully insured | Savings |
|---|---|---|---|---|---|---|---|
| Year 1 | 290 | 810 | 2,380 | 3,480 | 4,075 | 4,600 | 1,120 |
| Year 2 | 300 | 840 | 2,500 | 3,640 | 4,265 | 4,970 | 1,330 |
| Year 3 | 315 | 875 | 2,625 | 3,815 | 4,471 | 5,365 | 1,550 |
| Year 4 | 325 | 910 | 2,755 | 3,990 | 4,679 | 5,795 | 1,805 |
| Year 5 | 340 | 945 | 2,895 | 4,180 | 4,904 | 6,260 | 2,080 |
| Five-year total | 1,570 | 4,380 | 13,155 | 19,105 | 22,394 | 26,990 | 7,885 |
Representative example of roughly 250 employees, scaled from an executed proposal for a mid-size employer group; figures are illustrative and rounded, and are shown to explain how the funding model behaves rather than to quote or project your plan. Maximum self-funded cost assumes claims funded to the aggregate stop-loss attachment point — roughly 125% of expected — with fixed costs unchanged; your actual ceiling depends on attachment point, plan design, census and claims experience. The fully insured path assumes an 8% annual renewal increase.
Straight answers
“Doesn’t this mean worse benefits?”
It’s the first question every CFO and HR leader asks, and it deserves a real answer. Here are the objections we hear most — and what actually happens.
01Doesn’t this mean worse benefits for my employees?
No — and this is the part most people have backwards. Self-funding changes who pays the claims, not what gets covered. You keep the same national network, the same doctors, the same prescription coverage. Employees get a new ID card and, in most cases, notice nothing at all.
What changes is your leverage. Because you own the plan design instead of picking from a carrier’s standard menu, most of our clients use part of the savings to improve benefits — lower deductibles, better Rx coverage, added telehealth — and still spend less than they did fully insured.
02What happens if we have a catastrophic year?
That’s what stop-loss coverage is for, and it’s not optional — it’s built into every plan we design. Stop-loss caps two things: what you can pay on any single catastrophic claim, and what you can pay in total across the year.
Your worst case is a known, budgeted number before the plan year starts. The difference from fully insured isn’t that you take on unlimited risk — it’s that you stop paying a premium built to cover a bad year that never comes.
03Isn’t this only for huge companies?
It used to be. Today the market has moved down-market substantially: roughly 6 in 10 companies with 200–1,000 employees already self-fund, and it’s about 9 in 10 among the largest employers. Level-funded and captive arrangements have pushed the practical floor lower still.
Group size matters less than claims stability, industry, and how much your renewals have been climbing. That’s exactly what we model before recommending anything.
04Does our HR team suddenly have to run a health plan?
No. A third-party administrator handles claims processing, member services, ID cards, and reporting — the same functions the carrier performed. We select and manage that administrator on your behalf, along with the stop-loss carrier, the pharmacy arrangement, and the network.
In practice, HR’s workload usually goes down, because instead of an 800 number they get a named advisor who chases down claim problems and eligibility issues directly.
05What if we try it and it doesn’t work out?
Nothing about this is permanent. A self-funded plan is set up year to year, and a company can return to a fully insured arrangement at the next renewal. We’ve rarely seen it happen — once a company can see its own claims data, going back to a black box is a hard sell.
06How much cash do we need to have on hand?
Less than most people expect. Your monthly outlay is fixed costs — administration, stop-loss premium, network access — plus actual claims as they come in, and claims are capped by stop-loss. Many plans are structured with an aggregate accommodation feature so monthly cash flow stays level and predictable, much like a premium payment.
We build the funding schedule with your CFO before anything is signed, so there are no cash-flow surprises in month three.
Honest fit
Self-funding is not right for every company.
Any advisor who tells you otherwise is selling, not advising. Here is how we actually decide — and we will tell you plainly if you land on the right-hand side of this page.
This is probably a fit
Where self-funding tends to pay off quickly
- You have roughly 100 employees or more on the medical plan — enough lives for claims to behave predictably.
- Your renewals have come in at high single digits or worse for two or more years running, with little explanation.
- Your workforce is reasonably healthy relative to your industry, and your claims history has no persistent catastrophic driver.
- You have stable or growing headcount and can commit to a full plan year.
- Leadership wants to see the data — claims detail, cost drivers, pharmacy spend — and act on it.
- Health benefits are one of your top three expenses, and finance is looking for real dollars.
This is probably not — yet
When we would tell you to stay fully insured
- You are well under 50 employees, where a single large claim can swing a small pool hard.
- Your group has a known, ongoing catastrophic claim that stop-loss will price heavily.
- Cash flow is tight enough that month-to-month variability is a real problem, even with stop-loss in place.
- Headcount is volatile — seasonal swings or an imminent acquisition can distort the math.
- You have no appetite for a fiduciary role, even a supported one. Self-funding means you own the plan.
- You are mid-plan-year with a favorable rate locked in. Sometimes the right advice is to wait for renewal.
If you are not a fit, we will say so — and still help.
Plenty of the companies we work with are fully insured and staying that way for now. We shop their plan, negotiate the renewal, add dental and vision, and handle the day-to-day service their last broker did not. When self-funding does become the right move, we will already have the data to prove it.
Let us show you the math
Find out what your company would actually save.
Answer a few questions about your current plan and we will tell you plainly whether self-funding is worth exploring — and roughly what it would be worth. No pitch, no obligation, no cost. If the numbers do not work for you, we will say so.
You will hear back from us within one business day — from a person, not an auto-responder.
2 minutes
That is the whole ask. A few questions about headcount, renewal history, and how your plan is funded today.
Real numbers
We model your actual claims exposure and fixed costs — not a generic savings percentage pulled off a brochure.
A straight answer
If you are better off staying fully insured this year, we will tell you that and shop your renewal instead.