Self-Funded Insurance
An insurance arrangement where an organization assumes the financial risk for providing benefits to its members or employees, rather than purchasing traditional insurance. The organization pays claims directly from its own funds, often using a third-party administrator to process claims.
Example
“The manufacturing company switched to a self-funded insurance plan for their 500 employees, saving 15% on healthcare costs while maintaining the same level of coverage.”
Memory Tip
Think 'DIY insurance' - Do It Yourself by paying claims directly instead of paying premiums to an insurance company that pays the claims for you.
Why It Matters
Self-funded insurance can significantly reduce costs for organizations by eliminating insurance company profits and state premium taxes. It also provides greater flexibility in plan design and access to detailed claims data for better healthcare management.
Common Misconception
Many believe self-funded plans offer less protection than traditional insurance, but they often include stop-loss coverage that limits catastrophic losses. Some also think only huge corporations can self-fund, when groups as small as 25 employees can benefit from this approach.
In Practice
A 200-employee company previously paid $1.2 million annually in insurance premiums but switched to self-funding with a $150,000 stop-loss threshold. In year one, they paid $850,000 in actual claims, $180,000 in stop-loss premiums, and $60,000 in administrative fees, totaling $1.09 million. This saved them $110,000 compared to traditional insurance, and they earned interest on the $200,000 they maintained in a claims reserve fund. When an employee had a $300,000 heart surgery, the stop-loss insurance covered costs above $150,000.
Etymology
The term developed in the 1970s as large employers sought alternatives to traditional insurance, combining 'self' (indicating direct responsibility) with 'funded' (providing the financial resources) for insurance coverage.
Common Misspellings
Compare insurance quotes and save
Related Terms
More in insurance
Other insurance terms you should know
See Also
Need help with spelling?
Instant spelling checker with dialect variants for 2,000+ words.