07/20/2026
At a certain point, it becomes a financial question- not a benefits one.
"How can we financially justify staying fully insured?"
In today's market, fully insured health and benefit renewals are volatile, lack transparency, and can leave employers subsidizing risk they don't fully understand.
Yet some common reasons continue to pop up as to why companies don't explore alternative funding.
1. We only got a 5% increase being fully insured.
Good, but that just means the insurance carrier made a LOT of money off of you. You do not belong in the fully insured market and paying for more than you are getting. Often times companies wait until SHTF, and now what? Now you went from being better than your peers, to a group having problems looking for a last-ditch effort.
2. "We're not a fit."
According to who? Can your broker show you:
Your high-cost conditions?
Your pharmacy spend?
Your projected costs?
Where your healthcare dollars actually went?
Market benchmarks and trends?
What you are paying compared to others like you?
If the answer is no, how can anyone confidently say you're "not a fit"?
More importantly, if you truly aren't a fit today, what's the strategic plan to become one? You cannot monitor what you cannot see.
3. "We are scared of entering and having a big claim."
And you're not scared of that in the fully insured market?
Let's imagine someone on your plan gets a rare sickness. You get a 40% increase next year, and the year after that, the claims drop and the employee is healthy. Come renewal time, do you think the FI market is going to say, "Oh, sorry. You are healthy now; we will give you that 40% increase back....HA!
The beauty of self-funding is that each year starts over. You are in control, the losses are capped, you are protected, and if that does happen you have already planned for it.
In today's environment, "We are not a fit" isn't an answer without proof—it's a guess that should have been backed by data. Not an assumption. Not a habit. Not because "We tried it a few years back."
The decisions start with understanding your data—not accepting someone else's opinion. 30 employees or 500 employees, it is time to take control.
We transitioned 32 groups out of the fully insured market last year. The best thing is that even if you are not a fit right now, we can show you why and help you become one. With data based on your group specifically, we can confidently say you have better options.