Fully insured
Evaluate premium, plan design, employee contributions and renewal terms alongside the predictability of the contracted premium structure.
Evaluate funding alternatives in the context of your workforce, cash flow and tolerance for risk. Give finance and HR a shared view of the potential year—not just one projected cost.
Marc Adam Kravitz introduces a more considered approach to benefits funding, cost management and the range of potential outcomes.
Watch the introduction, then explore the considerations below.
Download the video (MP4)Evaluate premium, plan design, employee contributions and renewal terms alongside the predictability of the contracted premium structure.
Consider employer-funded claims, administration, stop-loss terms and cash flow. Level-funded arrangements require review of reconciliation, refunds, run-out and renewal obligations.
Assess whether sharing a defined layer of risk with other employers fits the organization. Distinguish claims funding and captive obligations from administration and stop-loss protection; examine capital, assessment and exit terms.
Model favorable claims experience using stated assumptions. Do not treat potential refunds, distributions or savings as guaranteed.
Compare a reasoned claims estimate plus fixed fees and other obligations with the current program or renewal, using consistent enrollment and benefit assumptions.
Stress-test claims exposure, stop-loss premiums, administrative fees and applicable captive obligations. Consider exclusions, enrollment changes, reimbursement timing and run-out; a claims attachment point is not an unconditional all-in spending cap.
Review provider access, pharmacy terms, employee experience, reporting and administrative responsibilities. Network availability and any savings depend on the actual arrangement. Scenarios are models—not guarantees—and require individualized financial, legal and benefits review.
Start with the question you’re trying to answer.
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