Level-Funded Plans

Level-Funded Health Insurance

A hybrid funding strategy that gives employers fixed monthly costs, stop-loss protection, and money back when claims run under budget.

Fully-Insured Premiums Keep Rising — With Nothing to Show For It

With a traditional fully-insured plan, you pay a fixed premium every year and the carrier keeps whatever they do not spend on claims. If your workforce is healthy, you are effectively subsidizing the carrier's margins. Most mid-size employers never see this money back and have no visibility into their own claims data.

How Nyala Health Helps

Level-funded plans charge a fixed monthly amount covering projected claims, stop-loss insurance, and administration — so your budget stays predictable. If actual claims come in below the funded amount, you receive a year-end surplus refund instead of the carrier keeping it. We evaluate whether level funding fits your group and manage the entire transition end to end.

  • Predictable fixed monthly costs
  • Year-end surplus refunds on favorable claims
  • Built-in stop-loss protection limits risk
  • Full claims data transparency
  • Ideal for groups of 25-500 employees
  • Typical savings of 15-35% versus fully-insured

Why Employers Choose Level-Funded Plans

Lower Costs

Healthy groups can save 15-35% compared to fully-insured plans, with surplus refunds returned directly to you.

Limited Risk

Stop-loss insurance caps your exposure, giving you the upside of self-funding without the unpredictable downside.

Full Transparency

Access to claims data lets you make informed decisions about plan design and future funding strategy.

Level-Funded Plans — Common Questions

What is a level-funded health plan?

A level-funded plan charges a fixed monthly amount that covers projected claims, stop-loss insurance, and administration fees. If claims come in under budget, the employer receives a year-end refund of the surplus.

Who is level funding right for?

Level funding works best for employers with 25-500 employees and a relatively healthy claims history. It is ideal for groups looking to reduce costs while limiting financial risk.

What is stop-loss insurance?

Stop-loss insurance is built into a level-funded plan to cap your financial exposure. If claims exceed the funded amount, the stop-loss carrier covers the excess, protecting your budget.

How much can we save with a level-funded plan?

Employers with favorable claims experience typically save 15-35% versus a comparable fully-insured plan, plus any year-end surplus refund.

Does Nyala Health manage the transition?

Yes. We evaluate whether level funding fits your group, model the potential savings, and manage the entire transition so there is no gap in coverage.

Curious if level funding could lower your costs?

Get a free analysis and we will model your potential savings and surplus refund.