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Fully insured vs. self-funded health plans

We're all about protecting the health of your employees and their families. And we want to protect the health of your business, too. That's why choosing a funding arrangement for your health plan is a big decision.

Fully insured: The risk free option

The most traditional type of health insurance funding where you pay a fixed and easy-to-budget premium to Wellmark every month. Then, we process and pay all claims for covered services to your employees.

Self-funded: Greater financial control

With self-funding, you directly fund the claims and only pay for the health care services actually used by your employees and their covered family members. A stop-loss option is also available, which lets you pay all claims up to a set limit until your stop-loss coverage kicks in and Wellmark pays the remaining claims.

Fully insured and self-funded comparison

Fully insured Self-funded
Ideal if you want to: Ideal if you want to:

Assume zero risk, since Wellmark assumes all risks and absorbs all the losses.

Protect yourself from the effects of high individual claims.

Not have to maintain claim reserves, as Wellmark assumes that responsibility.

Improve your cash flow, because you maintain your own reserves.

Assume risk and legal responsibilities and are comfortable with those responsibilities.

Save if your claims utilization is lower than expected.

Things to consider: Things to consider:

You'll have limited flexibility in controlling your financial liabilities.

Available for employers with 1+ enrolled employees.

Risk of experiencing higher-than-expected claims utilization.

Claims fluctuations may be difficult to budget.

Available for employers with 101+ enrolled employees.

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Lean on Wellmark for expert help in building a health plan solution to keep your employees healthy — and keep your costs down. Whatever your needs may be, you'll get the right solution. Every organization is unique, so we'll work together to determine the best funding for your business.