Tired of out-of-control health plan costs and one-size-fits-all options? There’s another way. Level-funded health plans are the rising solution for small and mid-sized employers looking for real cost control and a better benefits experience.

What’s the catch?

1. Cost Certainty Without the Surprises

• These plans bundle claims, admin, and stop-loss insurance into one tidy package—creating predictable monthly payments. If your group’s claims come in under budget, hello refund! 

2. Benefits, Your Way

• You get to pick from a robust list of plans —and add on perks, such as telehealth and behavioral health services — so it fits your team and your company. That’s a win for both HR and employees.

3. Insights = Smarter Decisions

• PAI brings the data—claims, trends, usage—so you can spot what’s driving costs and launch wellness moves that work.

Hot Trends HR and Brokers Should Know

• Pharmacy Policy Changes: New laws mean PBMs (pharmacy benefit managers) must be more transparent, passing rebates directly to you.
• Digital Health Upgrades: Telehealth, wellness apps, and AI-driven insights are streamlining claims and boosting employee health.
• Stop-Loss Tweaks: More flexible underwriting and attachment points mean smarter protection and pricing for employers.

Don’t Ignore Compliance

• ACA & ERISA: Level-funded plans are exempt from most state insurance laws, but strict federal ACA and ERISA rules still apply. Employers must handle key requirements like nondiscrimination testing, COBRA administration, and federal reporting—don’t assume less oversight means less responsibility. Stay proactive to avoid compliance slip-ups.
• Watch State Rules: Some states are tightening the reins on level-funding. Follow up with your state policies to stay informed.
• Transparency Matters: Stronger federal rules mean clearer cost information from TPAs and PBMs—make sure your partners are passing through potential savings.

What’s In It for Employers?

• Refund Potential: Healthy staff? You might get money back—giving incentives for healthy lifestyles can save on health care costs.
• Lower Premium Taxes: Fewer taxes = bigger savings.
• Built-In Flexibility: Shape plans to fit YOUR workforce, focus on what matters (mental health or preventive care).

Is Level-Funding Right for Your Clients?

Great For:

• Teams with stable/low claims
• Groups that want price transparency
• Companies tired of unpredictable, pooled rates

Maybe Not For:

• Groups with unpredictable, high-cost claims
• Employers who can’t dedicate time to plan management

👋 Ready to Level Fund?

As a seasoned healthcare TPA, we’ve got your back—with more than 40 years of experience in custom plan design, compliance help, real-time reports, and engagement tools that work — we can set you up for success.

Let’s chat! See how level-funded plans can help you (and your clients) save money, boost benefits, and stay on top of compliance in 2026 and beyond.

Want more info or a quick consult? Drop us a message and let’s get started! 🚀