As health insurance professionals, one of the most powerful ways to differentiate yourself is by introducing employers to funding models they may not fully understand. Level-funded plans are a prime example — a hybrid option that blends the predictability of fully insured coverage with the potential savings and transparency of self-funding.
What agents should know
A level-funded plan is structured so employers pay a fixed monthly amount that typically covers three buckets:
Dollars set aside to pay employee medical claims.
Protection that caps exposure on high-cost claims.
Plan administration, compliance support, and program fees.
The result: employers get the stability of a consistent monthly payment — while potentially benefiting if claims come in lower than expected.
Why it matters for your clients
Budget Predictability
Employers can plan around fixed monthly costs.
Upside Potential
Possible surplus refunds when claims run low (structure varies).
Transparency
More visibility into claims can improve decision-making over time.
Flexibility
Often more customizable than a traditional fully insured plan.
Positioning tips for agents
- Target the right employers. Focus on small to mid-sized groups (often ~25–250 lives) frustrated with annual renewal hikes.
- Lead with the “balance” message. It’s a middle ground: more control than fully insured, less risk than true self-funded.
- Make transparency a benefit. Even limited claims insights can help employers understand what drives costs.
- Set expectations clearly. Refund mechanics and underwriting rules vary by carrier/program — don’t oversell it.
A quick script you can use
This article is part of the HealthPlanBrief.com Agent Education Series, powered by Premier Shield Benefits — equipping agents and brokers with the tools, insights, and partnerships they need to thrive in today’s evolving health insurance market.
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