Tailored solutions for effective employee health benefits.

LEVEL FUNDED PLANS

Level-Funded Health Plans

Predictable monthly payments. An opportunity to benefit from lower claims.

Level funding offers employers another way to finance employee health benefits. It combines the structure of a monthly payment with the potential savings of a self-funded arrangement.

At Universal Benefit Plans, we help you compare level funding with traditional group insurance, ICHRA and other available options—so you understand both the opportunity and the financial responsibilities.

What is level funding?

A level-funded arrangement typically combines three components into one monthly payment:

  • Claims funding: Money set aside to pay
    employees’ and dependents’ covered medical claims.
  • Administration: Services such as claims
    processing, provider network access and plan administration.
  • Stop-loss insurance: Coverage that helps protect the
    employer against eligible claims exceeding specified thresholds, subject
    to the policy’s terms.

If claims are lower than expected, the arrangement may provide a share of unused
claims funds through a refund or credit. The amount, timing and eligibility depend on the contract; some arrangements require renewal to receive a surplus payment.

Level funding is a form of self-funding. A fixed monthly payment does not make it a fully insured policy.

What should employers expect?

The quoting process may involve reviewing employee demographics, health questionnaires or claims information, depending on the program.

Before enrolling, employers should understand the monthly payment, contractual maximum costs, stop-loss protection, surplus rules and responsibilities if the arrangement ends.

Employees generally receive an ID card and use the plan’s provider network. Doctor access, prescription coverage and out-of-pocket costs depend on the specific plan selected.

Potential advantages

  • More predictable budgeting: Monthly payments are generally established for the contract period, with adjustments permitted under the contract, such as enrollment changes.
  • Potential savings: Favorable claims experience may produce lower overall costs or a surplus payment.
  • Greater cost visibility: Available claims reporting can help explain what is driving plan spending.
  • Another option to compare: Level funding may provide an alternative to a traditional fully insured renewal.

Considerations and tradeoffs

  • Savings are not guaranteed. A lower initial quote does not ensure lower long-term costs.
  • Underwriting matters. Availability and pricing depend on the program and the group’s risk profile.
  • Renewal costs can change. Claims experience and expected future costs can affect renewal pricing and stop-loss terms.
  • Surplus payments have conditions. Employers may receive only part of the unused claims funds—or no payment.
  • Contract details matter. Stop-loss exclusions, funding obligations and claims paid after termination require careful review.
  • Employer responsibilities remain. Administrative support does not eliminate the employer’s applicable plan compliance obligations.

Could level funding fit your business?

Level funding may suit employers seeking more predictable payments and potential savings who are comfortable with underwriting and the responsibilities of a self-funded plan.

We help you compare the expected cost, financial exposure, employee coverage and renewal terms before deciding.

Our Resources

More on the Resources

Connect with Us: We're Here to Help