INSIGHT BEYOND INSURANCE resources | Self Funding PLans

Top 10 Attributes of Successful Self-Funded Benefits Plans 


The Top 10 Attributes of a Successful Self-funded Benefits Plan (1)

HERE'S a RECAP of the Attributes that make a self-funded plan thrive:

1. Realistic

Make sure your organization is cognizant of market dynamics including prescription drug costs, hospital pricing, employee health engagement, regulatory impacts and employee conditioning. Remember, Self-funding is the vehicle, not the destination.

2. Collaborative and Communicative

With 5 generations in the workforce, it’s important to recognize that each generations values their benefits program for different reasons, and is more comfortable with different methods of communication. More importantly, employers can be more transparent about the financial challenges that a plan faces, so employees realize why certain changes may be necessary. And how being a better healthcare consumer ultimately does impact them individually.

3. Intentional About Results 

Leaders of successful self-funded plans have an intense focus on the main drivers of plan spending. Create a multi-year strategic plan and support employees in navigating the healthcare system.

4. Financially 

When a self-funded plan is operating successfully the program is precisely aligned with actuarial values. So when contribution strategies are structured, employees are financially incented to choose the right plan, and the employer isn’t being “selected against”.  

5. Efficient and Aware

Learn from the information available to you and your team, then be transparent with large claims.

6. Informed

Regular analysis of your plan's data can lead to better overall decisions in the future. By utilizing data analytics tools that their advisor provides, employers can target the root causes of the claims instead of treating the symptoms.

7. Open-Minded to Solutions

The next level of results requires the next level of thinking. Focus on forward-thinking solutions in areas such as reference based reimbursement and direct primary care.

8. Innovative

As consumers in a digital age, our expectations have increased, and benefit programs are no exception. Provide employees with the self-serve resources to navigate the healthcare system in the moments that matter most.”

9. Vigilant

Continue to monitor the plan. Constantly be recasting throughout the year. Make sure you consistently analyze how your plan is running against the budget that was set.

10. Objective

Driving success in a self-funded program is predicated on working with a broker that has a deep understanding of these complex plans. Be objective in how you determine the right partner, and their expertise and resources will help steward your benefit program.


Additional Resources:

Springbuk Data Analytics

HealthJoy Features

Self-Funded Control - Milliman White Paper

Stop Loss Self-Funded Playbook

Related Reading:

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Self-insured health plan offerings growing among small employers



If I had to select one or two areas to focus on, what would they be?

Be open minded and objective. Make sure you're open to new solutions and closely analyze them. Looking at your broker stewardship and actuarial partnership and ask if you're getting the results you need in the long term.

How do we set the budget appropriately? How do we make changes in our plan if we haven't been structured?

Identify what issues of your plan you'd like to resolve. Also, identify what's best for your company culture and make sure your communicating that clearly with your actuarial partner.




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