Side Affects Episode 135 | Finding Middle Ground: Exploring Level Funded Health Plans

·30 min·2 clips

If claims run at 150, the carrier eats the difference in a level-funded plan.

1. McGohan Brabender Side Affects focuses on level-funded health plans for small employers. 2. Kenzie McEvely hosts, Dave Holman co-hosts, and Liz Schneider brings 15+ years at McGohan Brabender. 3. The episode asks whether level funding is a middle ground between fully insured and self-funded coverage. 4. Kenzie compares level funding to Goldilocks and the Three Bears, calling it “just right.” 5. Liz says carriers issue fixed premium equivalent rates at about 110% to 125% of expected claims. 6. She explains that applications, employee surveys, and historical claims data drive that underwriting estimate. 7. Liz says small employers can look and feel similar to fully insured groups while gaining reporting and possible premium return. 8. She cites Kaiser Family Foundation data showing adoption rising from 13% in 2020 to around 40% today. 9. The monthly payment stays level unless enrollment changes, which helps small employers budget cash flow. 10. Month-to-month reporting shows how claims compare with collected premium. 11. Liz says a strong claims year can produce a return of premium at contract end. 12. She says a group running at 150% of expected claims does not owe the carrier the difference. 13. The carrier absorbs the overage, and the next year’s expected rates adjust upward. 14. Liz cautions that return of premium is not realistic year after year. 15. She says employers can use claims data to plan multi-year population health strategies. 16. She points to specific actions like targeting pre-diabetes, diabetes, and hypertension through data. 17. The tone is practical, conversational, and filled with back-and-forth examples. 18. The format mixes employer questions, underwriting detail, and implementation warnings. 19. Small-business leaders comparing funding options and brokers. 20. People wanting a fast consumer-benefits overview can skip it.

As heard by us

A clear look at predictable premiums and the review work that still follows.

Level-funded health plans are presented as a workable middle ground between fully insured and self-funded coverage, and the focus stays on budgeting rather than jargon.

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Why you'd press play

You need a level-funded middle ground that feels budgetable, not mythical.

Read the full recommendation in PlayNext →

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