About Us

A self-funded health plan means our organization pays for employees’ healthcare claims directly, instead of paying fixed premiums to an insurance company. While the funding works differently behind the scenes, employees use their health plan the same way they always have — with ID cards, provider networks, and customer support.

Third Party Administrator (TPA) is a company licensed and actively regulated by state insurance authorities. The TPA: • Processes medical, dental, RX, and vision claims • Manages provider networks • Answers benefit and eligibility questions • Ensures the plan follows federal healthcare laws The TPA does not make benefit decisions or deny care for financial reasons — they administer the plan according to the rules outlined in the plan document.

Key Benefits of Self-Funding with a TPA: • Cost Savings & Cash Flow Management • Data Transparency and Utilization Control • Reduced Administrative Costs • Regulatory Flexibility • Stop-Loss Protection Any savings can be reinvested into the plan to support coverage, wellness programs, or future cost control.

Self-funding offers employers greater control and transparency over one of their largest expense categories — healthcare. Self-funding is the best thing in HR and fiscal circles. Key Strategic Advantages and Industry Trends • Cost Control: Pay for actual claims instead of carrier-priced premiums • Transparency: Access to detailed claims and utilization data • Flexibility: Ability to design benefits aligned to workforce needs • Cash Flow Efficiency: Funds remain with the organization until claims are paid • As of 2026, approximately 67% of U.S. workers are enrolled in self-funded plans, according to USDOL • While large firms (500+ employees) have historically high rates of self-funding (74-83%), smaller firms (3-199 employees) have seen a gradual increase in adoption, with 20% of small firms offering it by 2024. • The Robert Wood Johnson Foundation (RWJF) reports 10-25% lower non-claims costs by bypassing state insurance premium taxes, avoiding Affordable Care Act (ACA) health insurance taxes, and eliminating insurer profit margins.

No. You still: • Use your insurance ID card • Visit in-network doctors and hospitals • Receive covered services according to your medical plan The main difference is how the plan is funded, not how you access care.

Healthcare claims are paid from a dedicated health plan fund supported by the company and employee contributions. To protect the plan from very high or unexpected claims, the company also carries stop-loss insurance, which limits financial risk.