Self-Funded Health Plans

Your financial safety net against catastrophic claims

Stop-loss insurance is the cornerstone of every self-funded plan. It reimburses your company when claims exceed predetermined thresholds, potentially protecting you from the financial impact of a single catastrophic diagnosis or an unexpectedly high-claims year across your workforce.

Without stop-loss, self-funding leaves your company exposed to greater risk. With the right stop-loss structure, you can have meaningful protection while still taking advantage of the benefits of self-funding.

Phillips Financial shops the stop-loss market on your behalf, benchmarks attachment points against your claims history, and negotiates terms that balance premium cost with meaningful protection. We evaluate traditional individual carrier markets, captives, and employer consortiums to help find the right fit for your plan.

The operational engine of your self-funded plan

Your TPA is the day-to-day administrator of your health plan, processing claims, managing plan documents, fielding employee questions, and producing the data reports that make cost-containment possible. Choosing the right TPA is one of the most consequential decisions in a self-funded strategy.

Phillips Financial maintains relationships with leading TPAs and selects partners based on claims processing accuracy, reporting transparency, customer service responsiveness, and fee structure, not on referral arrangements. We hold TPAs accountable throughout the year, not just at renewal.

Prescription costs are rising 9–11% annually. Your PBM strategy is make-or-break

Prescription drugs now represent approximately 18% of total healthcare spending, with costs growing 10%+ annually. For self-funded employers, pharmacy cost management is one of the highest-leverage tools available. The difference between a traditional PBM and a transparent PBM can represent 20–30% savings on your total pharmacy spend.

Traditional PBMs under fully insured plans are notorious for "ingredient cost spread," charging you more than they pay the pharmacy and pocketing the difference. In a transparent PBM arrangement, rebates flow back to the plan, fees are disclosed, and you can audit claims. Phillips Financial focuses its recommendations on PBMs with transparent, pass-through pricing models.

The right network drives quality, access, and cost simultaneously

Self-funded plans have far more flexibility in network design than fully insured plans. Rather than accepting a carrier's pre-packaged network, you can layer notable networks, reference-based pricing arrangements, and direct provider contracts to optimize both access and cost.

The network is where most of your claims dollars are actually paid. A well-designed network strategy can reduce unit costs on medical claims by 15–25% through better reimbursement rates, centers of excellence for high-cost procedures, and reference-based pricing for facility claims.

Self-funded plans carry real legal responsibilities. We help keep you protected

Self-funded plans are governed by federal law under ERISA, which means you, as the plan sponsor, take on fiduciary responsibility. That's a legal duty to act in the best interest of plan participants. Most employers don't fully understand the compliance obligations that come with self-funding. We help make sure you do.

The regulatory landscape has grown significantly more complex since the Consolidated Appropriations Act (CAA) of 2021 introduced new transparency, reporting, and mental health parity requirements. Phillips Financial monitors these obligations, works with your TPA to fulfill them, and helps keep you prepared as regulations change.

You can't manage what you can't see. Full claims transparency is your competitive advantage

One of the most underutilized advantages of self-funding is complete claims data ownership. In a fully insured plan, your carrier owns that data and is under no obligation to share it. In a self-funded plan, you can see your claims, cost drivers, and utilization patterns, which means you can actually do something about them.

Phillips Financial reviews your claims data quarterly, identifies emerging cost trends before they compound, and uses that intelligence to inform plan design adjustments, wellness program targeting, and stop-loss renewal strategy. This data-driven approach is what separates a well-managed self-funded plan from an unmanaged one.

Proactive health management keeps people well and claims low

The best claims are the ones that never happen. Care management programs, from nurse hotlines and chronic disease management to second opinion services and transplant centers of excellence, are proven tools for improving health outcomes and reducing the frequency and severity of high-cost claims.

In a self-funded plan, money saved on preventable complications stays with your company instead of going to a carrier. We build care management into your plan design from the start, not as an afterthought.