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Level Funded Playbook

Level funded health insurance covers more than 12 million workers at small employers. Most of them cannot tell you how the money moves, who owns the risk, or what happens at year-end reconciliation. Most of the brokers who sold them the plan cannot either.

Level funded health insurance covers more than 12 million workers at small employers. Most of them cannot tell you how the money moves, who owns the risk, or what happens at year-end reconciliation. Most of the brokers who sold them the plan cannot either.

The Level Funded Playbook is a comprehensive analytical map of the product: the mechanics, the stop loss market, the regulatory framework, the employer populations the architecture was built for, and the ones it was not. It covers the cost drivers repricing the product faster than most advisors have noticed, the TPA operations that determine whether level funded delivers on its transparency promise or merely satisfies an administrative fee, and the geographic and workforce variables that determine whether the economics hold before the plan documents are signed.

The final series is a product proposal. The adjacent collection names populations the architecture left behind. The counter-thesis collection tests every major component against three questions a CEO actually asks: does coverage protect the company from financial risk, does the employee receive genuine health access, and is the arrangement honest.

This is not a guide to selling level funded. It is a map of how the product works, where it fails, who it serves, and what would have to be true for it to serve the next ten million workers the employer-sponsored insurance system is not currently reaching.

Series & Collections
LFP-01
The Architecture of Level Funded
Level funded feels like a premium and behaves like self-funding. The architecture that makes that possible involves three financial instruments, a statutory preemption framework that traces to 1974, …
LFP-02
Stop Loss: The Enabling Mechanism
Level funded is only as protective as its stop loss arrangement, and no more. The risk layer covers eight dimensions of the stop loss market: how the mechanism works, how carriers price what they …
LFP-03
Regulatory and Legal Structure
Self-funded plans exist outside state insurance regulation under federal law. They do not exist outside regulation. ERISA preemption, ACA carve-outs, CAA compliance obligations, mental health parity …
LFP-04
The Employer Market
The 1-to-50 market is five structurally distinct employer populations sharing a regulatory label. Below 10 lives, the actuarial math does not support level funded. Between 6 and 15, it begins to work …
LFP-05
TPA Operations
A level funded plan performs exactly as well as the TPA operating it, and most employers cannot evaluate TPA quality before they buy. The operational series covers the complete TPA function from …
LFP-06
Workforce and Demographics
Level funded's actuarial model is built on a worker who does not fully exist in the industries where the product has taken root. Ten populations reveal where the design assumptions break: senior …
LFP-07
Geography and Market Variation
A level funded plan performs differently depending on where it operates. Five geographic variables produce the conditions: state regulatory treatment, provider network density, stop loss carrier …
LFP-08
Alternative and Complementary Products
Level funded sits inside a frontier that includes ICHRA, association health plans, MEWAs, PEOs, group captives, portable benefit accounts, and products not yet built. Each alternative solves a …
LFP-09
Cost Drivers
Nine cost categories are reshaping the economics of small group level funded plans. Some arrive as single catastrophic claims: a gene therapy, a NICU delivery, a cancer biologic. Others erode through …
LFP-10
Cost Management Strategies
The TPA sits at the only position in the small group self-funded system with full visibility into the claims stream. This series builds the cost management case from that position: geographic price …
LFP-11
Ancillary and Supplemental Benefits
Most benefits packages are assembled by accumulation rather than by design. Series 11 tests each ancillary component against a single standard: does it connect to the level funded core in a way that …
LFP-12
AI and the Benefits Industry
AI is not primarily a story about healthcare technology. It is a story about the employment relationships that make employer-sponsored coverage possible. Series 12 follows AI's restructuring of those …
LFP-13
Technology Infrastructure
The technology stack most level funded TPAs operate was not assembled badly; it accumulated under constraint over decades. The claims engine is too old for real-time routing. The CRM was extended …
LFP-14
Distribution and Broker Economics
The broker sits between the employer and the product and controls whether the employer sees level funded at all. Series 14 follows that position through the compensation structures that shape …
LFP-15
A Tiered TPA Product
Series 15 is a product proposal, not market commentary. The evidence across 14 preceding series produces a design: three tiers serving three employer segments through three distribution channels, each …
LFP-16
The 65-Plus Entrepreneur
The 65-plus entrepreneur is the fastest-growing entrepreneurial cohort and the least-served population in the health coverage market. Medicare handles acute care well and leaves routine dental, …
TOS
The Other Side
The Other Side collection tests each component of the small group health benefits architecture against three objectives the employer actually has: protect the company from financial risk, provide …
ADJ
Adjacent Gaps
Some of the populations in this collection were never inside the small group benefits architecture by design. Others are legally covered but facing gaps created by default plan choices nobody …
FWD
Forward Looking
The employment relationship that made employer-sponsored insurance work is fracturing along three dimensions: the workforce is fragmenting into arrangements the coverage system cannot serve, the three …