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Knockout Showdown: Fully Insured vs. Self-Insured Employee Benefit Plans

February 22, 2024
Knockout Showdown: Fully Insured vs. Self-Insured Employee Benefit Plans

Did you know that 65% of covered workers, including 18% at small firms and 83% at large firms, are enrolled in self-funded health plans? 

Meanwhile, the average annual dollar amounts contributed by covered workers for fully funded plans in 2023 are revealing:

  • $1,401 for single coverage
  • $6,575 for family coverage

With 11% of covered workers encountering contributions exceeding $12,000 for family coverage, the world of employee benefits is in flux.

Every plan carries its own set of advantages and disadvantages. The following details provide an overview of each!

What are Fully Insured Group Plans?

Fully insured group plans are what most people think of when they hear "insurance." With this type of plan, you pay a fixed premium to an insurance carrier, and they assume the risk of covering your employees' healthcare expenses. It's like renting insurance coverage for your team. These plans typically offer predictable costs and a wide range of coverage options.


  • Predictable Costs: With fixed premiums, you know what you'll pay each month, making budgeting easier.
  • Administrative Ease: The insurance carrier handles claims processing and other administrative tasks, saving you time and hassle.
  • Broad Network: Fully insured plans often come with access to large provider networks, giving your employees plenty of options for healthcare providers.


  • Limited Flexibility: The insurance carrier's options may not fully meet your employees' needs.
  • High Premiums: Premiums for fully insured plans have the potential to be higher than self-insured options, cutting into your bottom line.
  • Lack of Customization: Customizing benefits to fit your company culture and employee demographics may be challenging with fully insured plans.

What are Self-Insured Employer Group Plans?

Self-insured employer group plans, on the other hand, flip the script. Instead of paying fixed premiums to an insurance carrier, you take on the risk and pay your employees' healthcare expenses directly. Think of it as owning your insurance coverage. While self-insured plans require more upfront financial responsibility, they offer greater flexibility and potential cost savings in the long run.


  • Cost Savings Potential: By assuming the risk and paying claims directly, you can save on premiums, especially if your employees are healthy.
  • Flexibility and Control: With self-insured plans, you have more control over plan design, allowing you to tailor benefits to fit your employees' needs and your company's budget.
  • Transparency: Since you're directly responsible for claims payments, you have full visibility into where your healthcare dollars are going.


  • Financial Risk: Self-insured plans can be risky! You may pay higher than expected claims, leading to financial strain if you do not manage them properly.
  • Limited Risk Management: With proper risk management strategies in place, CEOs and business owners 
  • CEOs and business owners often worry about the potential financial risks associated with self-insured plans, but with proper risk management strategies, you can avoid these concerns. 
  • Administrative Burden: Self-insured plans require more administrative oversight, including claims processing, compliance, and regulatory requirements.

Dispelling Myths and Addressing Concerns

Now, let's address some common myths and concerns surrounding self-insured plans. Contrary to popular belief, self-insurance isn't just for large companies. Businesses of all sizes can benefit from self-insured plans, especially with the proper guidance and risk management strategies. Additionally, self-insured plans offer flexibility, cost savings, and customization options that fully insured plans may lack.

Choosing between fully insured and self-insured employee benefit plans is a significant decision for any business owner. Both options have their pros and cons, and the right choice depends on your company's unique needs, risk tolerance, and budget. At Muneris Benefits, we specialize in helping businesses like yours navigate the complex world of employee benefits. Contact us today to learn more about your options and how we can assist you in finding the perfect plan for your team!

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