Group Health Insurance Options for Employers

At Root Health Insurance Solutions, I help businesses build benefit packages that support their people and their bottom line.

Fully-Insured Group Health Plans

A fully-insured plan is the traditional approach to group coverage.

• You pay a fixed monthly premium to an insurance company.
• The insurer handles claims processing and financial risk.
• Premiums may be adjusted annually based on claims history and overall risk.

There are several different plan types, with a range of network structures to suit you and your employees’ needs:

• HMO (Health Maintenance Organization)
  Lower cost, but more restrictions. Requires a primary care doctor and referrals. No out-of-network coverage except for emergencies.

• PPO (Preferred Provider Organization)
  Higher premiums but more flexibility. No referrals needed and broader provider access.



• HDHP (High-Deductible Health Plan)
  Designed for cost savings, usually paired with an HSA (Health Savings Account). Good for employees who use minimal care and want lower premiums.

Best for:

Employers who want a familiar plan model with predictable monthly costs and less financial risk.

Level-Funded Group Health Plans

Level-funded plans are a growing option for small and mid-sized employers. They offer the predictability of a fully insured plan with some of the cost-saving potential of self funding.



• You pay a fixed monthly amount that covers claims funding, stop-loss insurance, and administrative fees.
• If claims run low, you may receive a refund at the end of the year.
• If claims run high, you’re protected by stop-loss coverage.

Many carriers offer level-funded plans with access to national provider networks, making them competitive with traditional fully insured options.

Best for:

Employers who want cost control and claims transparency, without the full risk of self funding.

Self-Funded (Self-Insured) Plans

With a self-funded health plan, the employer takes on financial responsibility for employees’ medical claims instead of paying fixed premiums to an insurance company.



• You pay for claims as they’re incurred, often with the help of a third-party administrator (TPA) to handle billing and networks.
• Most employers purchase stop-loss insurance to protect against large or unexpected claims.
• Offers more transparency into claims data, which can inform cost-control strategies.

Best for:

Mid-size and large employers with predictable cash flow who want to customize their benefits and manage costs more directly. While self-funding can save money over time, it also comes with higher financial risk, especially for smaller companies without stop-loss protection.

How I Can Help

I am here to support you during open enrollment and throughout the year. I can help compare plans and design benefits packages, and offer guidance with enrollment and communications. I look forward to being your health insurance partner for immediate needs and long-term planning.

Group Health Insurance FAQ