Fully insured
Evaluate premium, plan design, employee contributions and renewal terms alongside the predictability of the contracted premium structure.
Employee Benefits
Look beyond
the renewal number.
Evaluate funding alternatives in the context of your workforce, cash flow and tolerance for risk. Give finance and HR a shared view of the potential year—not just one projected cost.
Funding alternatives
Different structures.
Different responsibilities.
Level-funded & self-funded
Consider employer-funded claims, administration, stop-loss terms and cash flow. Level-funded arrangements require review of reconciliation, refunds, run-out and renewal obligations.
Self-funded group captive
Assess whether sharing a defined layer of risk with other employers fits the organization. Distinguish claims funding and captive obligations from administration and stop-loss protection; examine capital, assessment and exit terms.
Scenario-led analysis
Three views of the year.
One informed decision.
Best case
Model favorable claims experience using stated assumptions. Do not treat potential refunds, distributions or savings as guaranteed.
Expected case
Compare a reasoned claims estimate plus fixed fees and other obligations with the current program or renewal, using consistent enrollment and benefit assumptions.
Worst case
Stress-test claims exposure, stop-loss premiums, administrative fees and applicable captive obligations. Consider exclusions, enrollment changes, reimbursement timing and run-out; a claims attachment point is not an unconditional all-in spending cap.
Cost is not the only consideration.
Review provider access, pharmacy terms, employee experience, reporting and administrative responsibilities. Network availability and any savings depend on the actual arrangement. Scenarios are models—not guarantees—and require individualized financial, legal and benefits review.
Let’s talk
What’s on your mind?
Start with the question you’re trying to answer.
mkravitz@sterlingrisk.com ↗Connect with Marc on LinkedIn ↗
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