If someone has ever talked to you about the advantages of self-funding, chances are they mentioned flexibility. But what does flexibility in a health plan really look like, and why is it so important?

Let’s break it down into the three main aspects:

1. Flexibility with Plan Design

Fully insured plans are subject to strict regulations regarding what they must offer. In contrast, self-funded plans, while still governed by the Affordable Care Act (ACA) and other regulations, face fewer constraints. This gives employers greater freedom to tailor health benefits more closely to their employees’ specific needs. For example, companies can:

• Provide consistent health benefits to employees across state lines
• Eliminate deductibles for preventive care or diabetic supplies
• Offer direct primary care, concierge care, or on-site clinics
  
  

Self-funded plans also offer greater transparency that allows employers to improve their plan design over time. Companies can access detailed claims data about which health conditions, prescriptions, or providers are driving costs. With this insight, they can implement targeted solutions that can help improve access to care and reduce expenses, such as chronic disease management for patients, patient care navigation tools, or early intervention programs.

2. Flexibility over Financial Risk

When employers switch to a self-funded health plan, they often purchase Stop Loss insurance to protect themselves from large medical claims. Stop Loss insurance acts as a safety net, capping the employer’s potential financial expose to high-dollar claims.

With a self-funded plan, employers choose their level of financial protection when they select their Stop Loss Specific deductible. While states may set minimum deductible thresholds, employers still have significant flexibility in choosing their deductible and coverage.

For example, an employer with high risk tolerance and strong cash flow might opt for a higher Stop Loss deductible—say, $200,000—taking on more risk, but also lowering its Stop Loss premium. Another employer might prefer a lower deductible, such as $50,000, for a more conservative approach. The key is aligning your strategy with your financial situation and risk appetite, which is why working with a knowledgeable benefits broker is essential.

3. Flexibility with Risk Sharing

Having a self-funded health plan unlocks other strategies and opens the door to risk sharing arrangements not available with fully insured plans. For example, an employer may feel it lacks the scale and size to self-fund on its own. By joining a Group Captive program, the employer can benefit from a proven risk-sharing arrangement that creates a larger pool of employees that can make health care costs more stable and predictable.

Berkley Accident and Health offers a wide range of Group Captive programs that go beyond a one-size-fits-all solution. This means each employer can select the program that fits its own financial position, risk tolerance, and long-term goals. Think of it like hiring a financial advisor who understands your unique situation, rather than following generic advice from a book.

Why Flexibility Matters

Flexibility in health plans is largely about managing risk—but it’s also about having choices. With self-funded plans, employers gain the ability to:

1. Work with their broker to customize their plan design
2. Retain the risk that is predictable
3. Transfer the risk that is unpredictable
4. Share the risk that is predictable at scale through a Group Captive program
5. Benefit from plan savings

With Berkley Accident and Health, you’ve got options. If you’re curious how our Group Captive programs can provide greater flexibility, contact us: https://www.berkleyah.com/find-an-expert/

Stop Loss is underwritten by Berkley Life and Health Insurance Company and/or StarNet Insurance Company, both member companies of W. R. Berkley Corporation and rated A+ (Superior) by A.M. Best, and involves the formation of a group captive insurance program that involves other employers and requires other legal entities. Berkley and its affiliates do not provide tax, legal, or regulatory advice concerning EmCap. You should seek appropriate tax, legal, regulatory, or other counsel regarding the EmCap program, including, but not limited to, counsel in the areas of ERISA, multiple employer welfare arrangements (MEWAs), taxation, and captives. EmCap is not available to all employers and may not be available in all states. Payment of claims under any insurance policy issued shall only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”).

BAH AD 2025-149       © Berkley Accident and Health     7/25