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Everything You Need to Know About Employee Benefits Compliance

As a business leader you work hard to take care of your employees. When it comes to employee health benefits, it’s important that you stay on top of ever-changing compliance requirements. Failing to do so can be detrimental to your business. Whether you are a growing startup, an established small business, or a scaling medium-sized corporation, in order to stay compliant, you need a systematic approach.

While these regulations are essential for assuring the fair treatment of employees, they can also be dense and intimidating if you have no prior experience navigating them. That’s why we’ve created this resource guide, to offer you a comprehensive look at employee benefits and the compliance requirements that come with them. With this resource, you can feel confident that you are taking care of your employee’s healthcare needs and while fulfilling your business’ legal obligations.

Employee Retirement Income Security Act (ERISA)

The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.

ERISA – General Guidelines

ERISA imposes a variety of compliance obligations on the sponsors and administrators of group health plans. For example, it establishes strict fiduciary duty standards for individuals that operate and manage employee benefit plans and requires that plans create and follow claims and appeals procedures. ERISA applies to employee welfare benefit plans, including group health plans, unless specifically exempted such as Church and government plans. There are no exceptions for small employers.

ERISA requires plan administrators to provide the following notices/disclosures:

  • SPD – Plan administrator must automatically provide an SPD to participants within 90 days of becoming covered by the plan. An updated SPD must be provided at least every five years if changes have been made to the information contained in the SPD. Otherwise, an updated SPD must be provided at least every 10 years.
  • Summary of Material Modifications (SMM) – Plan administrator must provide an SMM automatically to participants within 210 days after the end of the plan year in which the change was adopted. If benefits or services are materially reduced, participants generally must be provided with the SMM within 60 days from adoption.
  • Plan Documents – The plan administrator must provide copies of plan documents no later than 30 days after a written request.

ERISA – Form 5500 Requirements

Form 5500 is used to ensure that employee benefit plans are operated and managed according to ERISA’s requirements. The filing requirements vary according to the type of ERISA plan. Unless an extension applies, Form 5500 must be filed by the last day of the seventh month following the end of the plan year (that is, July 31 of the following year for calendar year plans.

The Form 5500 requirement applies to plan administrators of ERISA plans unless an exception applies. Small health plans (those with fewer than 100 participants) that are fully-insured, unfunded, or a combination of fully-insured and unfunded, are exempt from the Form 5500 filing requirement.

Affordable Care Act (ACA)

The Affordable Care Act (ACA) is a federal law that provides numerous rights and protections that make health coverage fairer and easier to understand, along with subsidies to make it more affordable.

ACA – General Guidelines

The ACA makes many changes to health coverage requirements, such as extending coverage for young adults up to age 26, prohibiting rescissions of health coverage (except in cases of fraud or intentional misrepresentation), eliminating pre-existing condition exclusions, prohibiting lifetime and annual dollar limits on essential health benefits, and requiring coverage for preventive care without cost-sharing. These health coverage reforms have staggered effective dates, with many key provisions taking effect for plan years beginning on or after Jan. 1, 2014.

The ACA applies to health plans and health insurance issuers, with narrow exceptions for certain types of plans (for example, retiree medical plans) and there are no exceptions for small employers.

ACA requires plan administrators to provide the following notices/disclosures:

  • Statement of Grandfathered Status – Plan administrator or issuer was required to provide the first statement before the first plan year beginning on or after Sept. 23, 2010. The statement must continue to be provided on a periodic basis with participant materials describing plan benefits. This requirement only applies to grandfathered plans.
  • Notice of Rescission – Plan administrator or issuer must provide a notice of rescission to affected participants at least 30 days before the rescission occurs.
  • Notice of Patient Protections and Selection of Providers – Plan administrator or issuer must provide a notice of patient protections/selection of providers whenever the summary plan description (SPD) or similar description of benefits is provided to a participant. These provisions relate to the choice of a health care professional and benefits for emergency services. The first notice should have been provided no later than the first day of the plan year beginning on or after Sept. 23, 2010. This requirement does not apply to grandfathered plans.
  • Uniform Summary of Benefits and Coverage – Plan administrator or issuer must provide the uniform summary of benefits and coverage (SBC) to participants and beneficiaries at certain times, including upon application for coverage and at renewal. Plan administrators and issuers must also provide a 60-day advance notice of material changes to the summary that take place mid-plan year. Plans and issuers were required to begin providing the SBC to participants and beneficiaries who enroll or re-enroll in plan coverage during an open enrollment period beginning with the first open enrollment period that started on or after Sept. 23, 2012. For participants and beneficiaries who enroll in plan coverage other than through an open enrollment period, the SBC requirement became effective for the first plan year that started on or after Sept. 23, 2012.

ACA – Employer Penalties and Related Reporting

Applicable large employers (those with at least 50 full-time employees, including equivalents) that do not offer health coverage will be subject to a penalty if any of their full-time employees receives a subsidy toward a health plan offered through an Exchange. The monthly penalty will be equal to the number of full-time employees (minus 30), multiplied by 1/12 of $2,000 for any applicable month. Applicable large employers that do offer coverage may be subject to penalties if the coverage is not “affordable” or does not provide “minimum value” and at least one full-time employee obtains a subsidy under an Exchange. The monthly penalty for each full-time employee who receives an Exchange credit will be 1/12 of $3,000 for any applicable month. However, the total penalty for an employer would be limited to the total number of full-time employees (minus 30), multiplied by 1/12 of $2,000 for any applicable month. A special transition rule applies to the penalty calculation for 2015 that allows employers with 100 or more full-time employees (including equivalents) to subtract 80 employees (rather than 30) from their full-time employee count.

The ACA imposes penalties on employers with at least 50 full-time (and full-time equivalent) employees if they do not offer health coverage to their employees or if they offer health coverage to their employees that is not “affordable” or does not provide “minimum value” and certain other requirements are met. Employers that are subject to the employer penalty rules are called “applicable large employers” (or ALEs).

General Notices

HIPAA Privacy and Security

The HIPAA Privacy Rule governs the use and disclosure of an individual’s Protected Health Information (PHI). The HIPAA Security Rule creates standards with respect to the protection of electronic PHI.

The HIPAA Privacy and Security Rules require the following notices/disclosures:

  • Notice of Privacy Practices – Plans and issuers must provide a Notice of Privacy Practices when a participant enrolls, upon request and within 60 days of a material revision. At least once every three years, participants must be notified about the notice’s availability.
  • Notice of Breach of Unsecured PHI – Covered entities and their business associates must provide notification following a breach of unsecured PHI without unreasonable delay and in no case later than 60 days following.


States may offer eligible low-income children and their families a premium assistance subsidy to help pay for employer-sponsored coverage. If an employer’s group health plan covers residents in a state that provides a premium subsidy, the employer must send an annual notice about the available assistance to all employees residing in the state.

CHIPRA requires the following notices/disclosures:

  • Annual Employer CHIP Notice – A model notice is available from the DOL

Medicare Part D

Employer-sponsored health plans offering prescription drug coverage to individuals who are eligible for coverage under Medicare Part D must comply with requirements on disclosure of creditable coverage and coordination of benefits

Medicare Part D requires the following notices/disclosures:

  • Disclosure Notices for Creditable or Non-Creditable Coverage – A disclosure notice must be provided to Medicare Part D eligible individuals who are covered by, or apply for, prescription drug coverage under the employer’s health plan. The purpose of the notice is to disclose the status (creditable or non-creditable) of the group health plan’s prescription drug coverage. It must be provided at certain times, including before the Medicare Part D Annual Coordinated Election Period (October 15 through December 7 of each year).
  • Disclosure to CMS – On an annual basis (within 60 days after the beginning of the plan year) and upon any change that affects the plan’s creditable coverage status, employers must disclose to the Centers for Medicare and Medicaid Services (CMS) whether the plan’s coverage is creditable.

Michelle’s Law

Michelle’s law ensures that dependent students who take a medically necessary leave of absence do not lose health insurance coverage. (Note: The health care reform law expanded coverage requirements for dependents by requiring plans to provide coverage up to age 26, regardless of student status.)

Plan administrators and issuers must include a Notice of Michelle’s Law with any notice regarding a requirement for certification of student status.


Under the Newborns’ and Mothers’ Health Protection Act (NMHPA), group health plans may not restrict mothers’ and newborns’ benefits for hospital stays to less than 48 hours following a vaginal delivery and 96 hours following a delivery by cesarean section.

The plan’s SPD must include a statement describing the NMHPA’s protections for mothers and newborns.


The Women’s Health and Cancer Rights Act (WHCRA) requires health plans that provide medical and surgical benefits for a mastectomy to also cover: (1) all stages of reconstruction of the breast on which a mastectomy has been performed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) prostheses and physical complications of mastectomy, including lymphedemas.

Plans must provide a notice describing rights under WHCRA upon enrollment and on an annual basis after enrollment.

Your Benefits Compliance Checklist:

  • ERISA – General Guidelines
  • ERISA – Form 5500 Requirements
  • ACA – General Guidelines
  • ACA – Employer Penalties and Related Reporting
  • HIPAA Privacy and Security
  • Medicare Part D
  • Michelle’s Law
  • Newborns’ and Mothers’ Health Protection Act (NMHPA)
  • Women’s Health and Cancer Rights Act (WHCRA)


There’s a lot to know when it comes to employee benefits compliance. At Launchways, we understand and are here to help as your benefits experts. We have the expertise to ensure that your benefits compliance needs are taken care of, so you can have the peace of mind your business is always in compliance.  No matter the size of your business, if you offer your employees any form of health insurance benefits, you must feel confident that you are compliant in your offerings. Talk to a Launchways team member today about our benefits administration solution.

Interested in more information on benefits compliance?

Get The Complete Benefits Compliance Overview!

This guide includes:

  • How to determine your plan year
  • Full calendar-style checklist of every compliance deadline your business must meet
  • In-depth details on how to fulfill each compliance requirement


The Top 11 Employee Benefit Challenges Facing Today’s Businesses

At Launchways, we pride ourselves on working closely with each individual client to identify their workforce’s unique needs, navigate their business model’s unique challenges, and leverage emerging best practices to help them create employee benefit packages that truly support their workers without breaking the bank.

As we near the end of 2019, we’ve been reflecting on the most common client challenges we saw this year, and we’ve decided to share this list of the Top 11 Employee Benefit Challenges Facing Today’s Businesses.

Here are the most pressing challenges we see assist our clients with on their employee benefits programs:

Rising Healthcare Costs

Doctor visits, prescription drugs, and medical procedures are more expensive than ever before, and it’s difficult to envision that paradigm reversing in the near future. Media coverage surrounding healthcare costs does a good job illustrating the impact on individual patients, but the increased burden on businesses often goes unvoiced.

Every business wants to support their employees’ and their families in times of personal and medical need, but the incredible costs associated with certain long-term courses of treatment is causing some businesses to feel nervous about the financial impact of offering comprehensive coverage.

These tensions reinforce why it’s so important to partner with the right employee benefits broker who you know is working in the best interest of both your employees and your business to deliver maximum benefits value at the lowest possible cost.

Understanding Employee Healthcare Needs

One of the biggest areas of loss in all of human resources is the lack of alignment between employee healthcare needs and the benefits packages offered. If benefits plans are too rich, it can cause undue waste of business resources.

At the same time, however, shortfalls in coverage can be financially and personally devastating to employees. That’s why tailoring your benefit offerings to employee needs is crucial to hitting the sweet spot of comprehensive coverage and well-scaled costs.

Analyzing employee healthcare usage data, available through your carrier, can be extremely useful in this diagnostic work. Only when you know what your employees truly need can you optimize your offerings.

ACA Compliance

The Affordable Care Act presents different challenges to organizations depending on their scale, with specific regulations based on employee headcount. Many growing or early-stage businesses break into different tiers as they develop, and without proactive management, that can lead to accidental non-compliance.

Knowing the ACA inside and out is a must for any employee benefits specialist, and it’s also important to allocate co-planning time between HR and finance to discuss how employee benefits programs will need to grow to account for regulations as the business progresses.

If you don’t understand what the ACA demands of your business, engage a compliance partner to help you navigate these complex issues.

The Rising Relevance of Mental Health

Our shared cultural understanding of health and well-being have shifted a great deal in recent years, and simply taking care of employees’ bodies is no longer enough. Mental wellness is just as important to success at work and away from the office as our traditional understanding of physical health and therefore must assume its proper place as a cornerstone of your overall employee benefits strategy.

There are many businesses out there today who are failing to provide their employees with an affordable and accessible framework to get the therapy and medication they need, and businesses are often unaware this gap exists. Across the industry, support for mental health must catch up to awareness.

Due to decades of stigma and denial, even talking about mental health at work can be challenging at first, but in the 2020s, the businesses with the strongest approach to mental health will be the ones with the highest-performing teams.

Overreliance on Narrow Networks

A decade or so ago, benefits were trending toward narrow networks, with the thought being that both patients and their employers could save more money by staying relatively local and working with a tighter healthcare team. In reality, narrow networks provide the most benefit to the professionals who are doing the billing, not the paying, by ensuring a steady patient flow.

Narrow networks can be a nightmare for new employees who have existing relationships with out-of-network doctors or team members who get life-changing diagnoses and want to pursue all options. They also prevent patients from price shopping, which means you and your employees are stuck paying whatever the in-network provider dictates, even if it’s not the best deal.

Legacy narrow network healthcare is an underappreciated obstacle to talent recruitment and retention, especially for organizations targeting a younger or more diverse talent pool.

Offering a Qualified HDHP, but Not an HSA Strategy

High-Deductible Health Plans are always a great option for young or single employees who do not require much coverage, and they also provide tremendous savings for employers. With that said, however, an HDHP can easily fail an employee who has sudden or unexpected medical needs that transform their medical care into a mountain of debt.

If you offer HDHPs, it’s crucial that you protect your employees by extending a Health Savings Account option. Using the HSA, you can help your employees fill in the gaps in their HDHP coverage and limit their out-of-pocket expenses, while still saving money compared to the price of a lower-deductible plan.

As an employer, you must build benefits and incentives for employees who have helped you out by selecting less expensive coverage options, and the HSA is a best practice for returning that value back.

Educating the Workforce on Benefits

As we said earlier, one of the biggest areas of unnecessary spend for many businesses is unused benefits. The root cause of that disuse is often a lack of awareness, either because employees don’t know the benefits exist or they don’t know understand how they would benefit from them.

Additionally, millions of workers who don’t know which benefit package is right for them unwittingly set themselves and their employers up for failure every year. As a proactive business leader, it’s your job to give your team members the knowledge and tools they need to help themselves (and you) when it comes to benefit elections.

Employee education is fundamental to any organization getting benefits right at scale. Finding the right approach requires thinking like a teacher and having a clear vision of what an optimized system will look like.

Out-of-Date Dental and Vision Plans

People used to think dental and vision were “the easy part” of employee benefits, but as technology has improved both fields, new approaches have been innovated and care has gotten more expensive. For many businesses with a legacy approach to benefits, their dental and vision plans are simply out-of-step with the times.

Dental plans need to account for new approaches like implant dentistry and cover a wider range of surgical procedures to make great dentistry accessible to more people. Similarly, vision plans must account for corrective laser procedures, innovative cataract removals, and so on.

Accessibility to dental and vision care greatly impact employees’ and their families’ long-term health and well-being. If your insurance offerings only cover procedures that were common in the ‘90s, you should look at revising your plan.

Benefits Administration and Integration with Payroll & HRIS

As we all know, HR professionals balance an incredible number of responsibilities, both human and administrative. One of the things that makes those day-to-day tasks so frustrating is the lack of integration between the tools they require to do their work.

For example, some HR professionals utilize an HRIS to archive employee data, an HCM for people management, a benefits administration system, and a payroll portal for financial transactions. Without backend integration between these apps and tools, professionals have to do a great deal of repeat data entry, leading to lost productivity and potentially costly transposition errors.

In order to run an efficient HR department that can manage benefits and other concerns in a daily, proactive manner, every organization needs to move towards a single integrated system for employee benefits, payroll, human capital management, and beyond.

Managing Short-Term Disability and FMLA

Disability and Family and Medical Leave provide a crucial safety net for all workers. However, as an employer, you have a variety of obligations and responsibilities when an employee applies for leave.

Too many organizations lack clear procedures for leave application and approval, leaving themselves open to strained relationships with employees and potentially costly lawsuits. The more proactive you can be in laying out policy for giving employees the family or recovery time they need while maintaining internal productivity, the better a support you can be for your team members and your organization as a whole.

Each business should have a clear approach to the leave application process, transparent approval criteria, and an established re-entry plan for employees when their leave is over.

Finding Alternative Funding Strategies

As our first ten challenges have illustrated, providing strong employee benefits is increasingly about flexibility and scale. The best programs are the ones tailored to the specific needs of your employees with maximum value and accessibility in mind.

With that said, it can be tough to achieve that bespoke feel with a traditional fully-funded health insurance program. The total freedom of self-funding might not be possible for all businesses, but there are a variety of new and innovative ways you can connect with alternative funding to build something more personalized.

If you’re intrigued about changing your funding model to create a more open-ended, employee-centric approach to healthcare, talk to your leadership team and benefits broker about exploring new possibilities.

Still Fully-Insured? A Growing Business’ Pathway to Self-Funding

Most businesses begin their employee benefit journey fully-insured for good reason. Early in a business’ growth cycle, it’s highly advantageous to keep monthly healthcare expenses predictable and under control, with any variation squarely the carrier’s problem.

However, once a business has grown past that developmental stage and stabilized with a properly scaled workforce and projections of continued success, self-funding becomes increasingly attractive. When businesses self-fund, they gain more granular access to their bottom-line healthcare expenses and can potentially save money in the long term by assuming increased benefit management responsibilities and opening themselves up to a little more risk.

Moving forward, we’ll explore:
• Why growing businesses should transition toward self-funding
• First steps for businesses looking to self-fund
• Important planning considerations for organizations hoping to self-fund
• The advantages and disadvantages of level funding

Why Transition Toward Self-Funding?
Shifting toward a self-funded benefits program is a major decision for any organization and not something that can be accomplished without a great deal of planning and follow-through. While the process may sound daunting for HR and finance leaders accustomed to fully-insured processes, there are tangible benefits available for those brave and organized enough to make self-funding a priority.

Leveraging Your Business’ Stability to Reduce Overspend
Self-funding uses organizational size and stability to reduce average monthly costs, as the employer significantly lowers overhead by paying a variable monthly fee based directly on employee claims (healthcare usage).

While there are increased internal management responsibilities for benefits professionals on the HR team in self-funded scenarios, there are also significant gains, as organizations reduce administrative fees and take power back from carriers when it comes to dictating monthly costs. That kind of overspend reduction can help tighten up an employee compensation budget for HR departments looking to stay streamlined for company growth, even if headcount begins to rise.

Businesses don’t need to be large to benefit from self-funding, either. In the right scenarios, self-funding is possible at almost any scale, as long as the employer truly understands what their employees need and will use in terms of healthcare.

Why Variable Cost can be Preferable to Fixed Premiums
Many risk-averse planners might be tempted to stick with the predictability of fixed-rate, fully-insured plans because the number you know is much less daunting than a worst-case-scenario figure. However, stop-loss and excess-loss coverage are specifically available to limit the financial blow of catastrophic claims scenarios, which means that a month of coverage for a healthy workforce could, in many situations, be significantly cheaper than a month at the fully-insured rate.

Furthermore, if the employer maintains a healthy workforce where daily wellness and preventative medicine are values and priorities, expensive trips to the emergency room and invasive procedures are minimized through plan design and education. That means self-funded companies can exponentially increase their benefit if they establish a (or take advantage of an existing) meaningful culture of wellness.

Leveraging a self-funded plan might seem like a risky and costly expense, but it’s actually a long-term investment in the company’s ability to grow and work better. In the same way, the potentially increased cost of self-funded insurance is mitigated by the opportunity to reduce inefficiencies and overspend in most cases.

Providing Exactly What Your Employees Need
Of course, in any conversation about employee benefits, the benefit of the employees needs to be a central focus. Working for a company with self-funded insurance is beneficial to team members throughout the organization, as the savings from reduced administrated costs can be passed down from the employer to individual policy-holders.

Additionally, self-funding means the employer has more specific control over benefit offerings and, with a strong understanding of employee needs, can design plans in a more thoughtful, specific, and employee-focused way than ever before. Of course, businesses can only achieve that if they have a rich, detailed knowledge of their employees’ and their families’ medical needs, claims-related behaviors, and emerging trends and technology that connect employees with medicine and medical professionals in innovative and cost-effective ways.

Maximizing a self-funding transition requires incredible preparation and a robust base of knowledge about both plan design generally and each individual organization’s specific finance picture, needs, and goals.

Preparing to Self-Fund
Achieving self-funding is a journey unto itself that forces HR and finance to work together to establish the best-possible understanding of needs, possible solutions, and the impact of each on the bottom line.

The Importance of Preparation
In short, if a self-funded employee benefits program is not designed and scaled correctly, it can significantly harm the company’s ability to maximize profitability. On the other hand, though, getting self-funding right opens the door to a variety of gains for both the business and its employees. The difference between those two outcomes is good planning.

Altering a benefit funding model is a paradigm shift that no one professional or department can make happen on their own. Cross-department planning and collaboration must occur in order for all relevant decision-makers to get a full picture of current healthcare costs, the possible impact of transitioning toward self-funding, how benefit offerings will change, etc. That means input from HR, finance, the boardroom, and beyond is necessary to plan for a strong, positive transition.

When HR, finance, and senior leadership have a shared understanding of how self-funding will reduce overspend without tying the company’s hands in a way that impacts profitability, then the real design work starts.

Understanding and Planning for Risks
One of the reasons self-funding is such a cost-saver is because, in self-funding, a business assumes a great deal more variable risk. In a fully-funded scenario, a catastrophic accident or life-changing diagnosis to an employee impacts a company’s healthcare fees very minimally – that security is part of what businesses pay for. Once a business is self-funded, however, a major uptick in claims or a string of big-ticket claims can certainly eat into profitability for the month or quarter.

Minimizing those risks requires researching stop-loss and excess-loss coverage and determining how that coverage should be scaled to your workforce and its needs to provide the business with the profitability protection it requires. Reducing the risk of such high-cost events from occurring through employee health and wellness offerings (which are significantly cheaper than the cost of reactive medical care) is another crucial proactive planning measure.

Maximizing the Data Available to You
Designing a self-funded plan requires a rich understanding of the benefits and services employees absolutely need. By studying the healthcare utilization data available through their providers, HR leaders and CFOs can get a very clear, specific understanding of what kind of services employees are using regularly and what their actual costs are.

That data is incredibly valuable in planning what a standard “month” of real expenses in a self-funded scenario might look like compared to current fully-funded costs. Again, the transition toward self-funding cannot be made or even attempted until that data story is fully understood, or else the company is simply self-funding for the sake of self-funding, rather than making an educated, profit-minded decision to improve healthcare efficiency.

Scaling Your Benefit Plans to Your Funding Goals
Once a commitment to self-funding has been made and HR and finance have worked together to understand how the transition will support company growth and translate to more efficient spending, the next step is to think about how the change in funding model will affect specific benefits offerings.

To be blunt, plan design is more important than ever for HR to ensure self-funding is efficient at scale and supports growth. Armed with utilization data and other measures of employee need such as surveys, internal leadership must work with a benefits broker who understands the transition plan and the importance of plan success in order to create benefits packages that are highly valuable to team members while remaining mindful of the bottom line.

To guarantee success, no HR leader or department should be working on their own during this period. Input from leadership, finance, and your benefits broker can be incredibly useful to ensure proper perspective is maintained and the transition plan is well-aligned with short- and long-term company goals.

Meeting in the Middle: What about Level Funding?
Some organizations looking to transition away from a fully-funded approach without completely losing their safety net may be interested in what is known as “level funding.” Level funding provides a middle ground between fully- and self-funded benefits programs, in which the carrier and the employer share responsibility.

What is Level Funding?
In a level funding scenario, an organization pays a set monthly fee to an insurance carrier, as in traditional fully-funded plans. However, the carrier tracks actual employee usage and claims throughout the year so that at year’s end, the difference between the actual claims and the monthly fees can be determined.

If the employer organization’s monthly spending equals more than the total of the claims at the end of the year, they are reimbursed the difference. However, if the value of the claims is greater than the amount the employer paid in, they must pay the carrier the difference.

Level funding can be highly beneficial for businesses who understand their utilization picture extremely well and can predict with great certainty that they will be will not stray an acceptable percentage from the projected payments. On the other hand, if an organization goes into a level funding situation without truly understanding their employees’ needs, it can lead to an additional payment at year’s end.

In short, level funding protects businesses from many of the administrative challenges of self-funding but doesn’t carry the same cost-saving benefits as a well-planned, well-executed self-funded approach.

Key Takeaways
The transition from fully-funded insurance offerings toward a self-funded program is one of the biggest and most important adjustments an HR department can oversee. Pulled off successfully, a self-funding initiative can streamline healthcare costs while keeping the entire team productive and well-supported. Scaled, planned for, or executed incorrectly, however, self-funding attempts can put a major strain on a business’ month-to-month profitability.

If you’re an HR professional or finance leader starting to consider whether your organization is ready to begin the journey toward self-funding, remember:
• Self-funding is a great way to reduce healthcare overspend by embracing variable fees month to month
• In a self-funded model, employer healthcare costs are based on actual usage, not projections
• Transitioning toward self-funding is a crucial shift that requires organization-wide commitment and extensive planning
o Healthcare utilization data can be valuable in this work
o Understanding risks and connecting with the coverage needed to mitigate them is crucial
• Partnership with finance is necessary to ensure benefits offerings are scaled with company capabilities and objectives
• Level funding offers a blend between self- and fully-funded approaches that eliminates both the best- and worst-case scenarios for self-funding failure/success
• Working with the right employee benefits broker can help your business smoothly transition to a self-funded strategy