Beyond the Basics: A Broker’s Guide to Smarter Health Plan Strategies
Health insurance has long been a fixed line item in an employer’s budget—a predictable, if often painful, cost. But in 2025, that predictability is under scrutiny. Rising premiums, limited flexibility, and a push for more personalized benefits are forcing employers to rethink their approach. For brokers, this presents an opportunity: not just to sell plans, but to offer smarter strategies.
That’s where the conversation shifts from fully insured to self-funded health plans. But this isn’t just about comparing premiums and deductibles. It’s about helping your clients understand risk, control, and long-term value. Here’s how to lead that conversation and position yourself as the expert your clients need.
The Real Difference: Who Holds the Risk?
For years, fully insured plans have been the go-to option. Employers pay a fixed premium to an insurance carrier, who takes on the financial risk of employee claims. It’s simple, predictable, and easy to manage—but often comes with inflated costs and little transparency.
Self-funding flips the script. Instead of paying premiums, employers pay for actual claims as they arise. With the right safeguards—like stop-loss insurance to cap high-cost claims—employers can save significantly while gaining more control over plan design.
But here’s the catch: self-funding isn’t just about cost savings. It’s about empowerment. Employers gain access to claims data, allowing them to identify trends, manage chronic conditions, and invest in wellness programs that reduce future claims.
Why Brokers Are Recommending Self-Funding
It’s not just about cutting costs (though that’s certainly part of it). Self-funding offers brokers a chance to deliver more value to their clients:
- Cost Control: Instead of paying for coverage they might not use, employers only pay for the care their employees actually need. In years with fewer claims, they keep the savings.
- Plan Flexibility: Self-funded plans allow employers to design benefits that fit their workforce—whether that means expanded mental health support, chronic disease management, or specialized programs.
- Transparency and Insights: Unlike fully insured plans, self-funding provides access to detailed claims data. Employers can see exactly where their healthcare dollars are going and make informed decisions.
- Tax Advantages: Self-funded plans avoid state premium taxes and certain ACA-related fees, further enhancing cost savings.
For brokers, self-funding isn’t just another option—it’s a way to position yourself as a strategic partner, helping clients move from passive cost management to active plan optimization.
Is Self-Funding Right for Every Client?
While the advantages are clear, self-funding isn’t a one-size-fits-all solution. For smaller employers with limited cash flow or risk tolerance, a fully insured plan may still be the best fit. That’s where hybrid solutions, like level-funded plans, come in.
Level-funded plans combine the predictability of fully insured premiums with the cost savings potential of self-funding. Employers pay a fixed monthly amount, but if claims come in under budget, they get money back. It’s a middle ground that offers control without exposing clients to excessive risk.
How Brokers Lead the Conversation
When discussing self-funding with clients, it’s not enough to highlight savings. The real value lies in aligning the health plan with the client’s business goals and workforce needs. Here’s how to approach it:
- Start with Data: Review the client’s past claims experience. Are they consistently overpaying for coverage they don’t use? Are there chronic conditions driving costs that could be better managed?
- Highlight Flexibility: Emphasize how self-funding allows employers to build a plan around their workforce—whether that means expanding mental health benefits, offering virtual care, or covering specific treatments.
- Address Risk Transparently: Self-funding does involve risk, but stop-loss insurance can mitigate exposure. Make sure clients understand how these safeguards work.
- Promote Long-Term Value: Self-funding isn’t just about next year’s premium—it’s about building a sustainable, cost-effective benefits strategy for the future.
Why Blackhawk?
Navigating self-funding requires expertise, and that’s where Blackhawk shines. With tailored solutions, real-time claims insights, and comprehensive administrative support, Blackhawk empowers brokers to deliver smarter strategies without adding complexity.
From stop-loss protection to plan design and compliance support, Blackhawk ensures that brokers can confidently guide their clients toward self-funding—whether they’re ready to fully transition or just exploring their options.
Let’s Talk Strategy
In today’s market, brokers aren’t just plan providers—they’re trusted advisors. Helping clients navigate the self-funding conversation isn’t just about lowering costs; it’s about delivering smarter, more sustainable solutions.
Ready to lead the conversation? Let’s talk about how Blackhawk can support you in bringing smarter health plan strategies to your clients.