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Series

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 pre-Medicare workers with purchasing power but no product, low-wage workers with coverage that functions as cost shifting, fractional professionals outside the employment relationship, and workers in high-turnover industries the plan-year architecture was not built to serve.

The Level Funded Workforce: Who These Plans Actually Cover and Who They Miss

Stop loss underwrites against an abstracted worker: full-time, 12-month tenure, demographically predictable. The series examines what actually works for the small employers where …

The 55-to-64 Cohort: Senior Entrepreneurs in the Pre-Medicare Coverage Desert

Workers between 55 and Medicare eligibility have spending rates nearly double those of workers in their late thirties, chronic condition prevalence approaching 70 percent, and …

Fractional and Portfolio Workers: The Structurally Uninsured Professional Class

The fractional CFO earning $200,000 across five clients has no pathway to employer-sponsored insurance because none of those clients employs her under ERISA. The income is not the …

Low-Wage Workers in Level Funded Industries: Cost Shifting Dressed as Coverage

A $2,575 deductible consumes 7.4 percent of a home health aide's $34,900 annual income before the plan covers most of her claims. She has a coverage card. She will avoid care, then …

Workers With Chronic Conditions: The Tension Between Risk Selection and Adequate Coverage

A level funded plan cannot exclude members based on health status. The stop loss carrier that underwrites the plan can. The gap between those two rules is the structural tension …

Mental Health in the Level Funded Workforce: Parity on Paper, Gaps in Practice

MHPAEA requires mental health benefits to be no more restrictive than medical benefits, with a $100 per day penalty per affected individual for violations. Most small level funded …

Access Barriers: Rural Networks, Language, and the Members the System Was Not Built For

A coverage card in a rural or language-isolated community where the plan's network has no accessible in-network physicians is not functional coverage. The network discount means …

High Turnover and the Coverage Cliff: What Happens to Workers Who Churn Through Level Funded

The plan year runs 12 months. Home health care annual turnover frequently exceeds 60 percent. A worker employed for four months, covered for three, then separated faces COBRA …

Undocumented Workers in Level Funded Industries: The Coverage Boundary Nobody Discusses

Construction, landscaping, food processing, and hospitality are industries where level funded is growing and where undocumented workers represent a significant share of the labor …

Dependents: Spouses, Children, Aging Parents, and the Coverage Complexity That Follows Families

A 20-person employer with 35 dependents sponsors a 55-member plan. The employee population may be young and healthy. The dependents carry the biologic medications, the ABA therapy, …

Who Level Funded Serves and Who It Fails: The Coverage Map and Its Gaps

Level funded embeds five assumptions about the member: stable employment, full-year enrollment, manageable cost-sharing relative to income, accessible provider network, and …