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At this size the health plan is usually one of the largest line items in the budget. The questions shift from which plan to funding, data, pharmacy and process.
In most states we serve, a group this size is in the large group market, where renewals reflect your own experience. In New York, a group of exactly 100 is still small group; 101 or more is large group. Form 5500 filing generally applies once an insured plan has 100 or more participants at the start of the plan year; that counts covered employees, COBRA participants and retirees, not your total headcount.
This is the size where self-funding with stop-loss becomes realistic for many groups, pharmacy becomes the line to manage, and a written process with data, timelines and a decision memo beats a renewal that simply rolls over.
Insured plans generally file once they have 100 or more participants at the start of the plan year, and a plan that holds money in a trust or separate fund can owe it below 100. Covered employees, COBRA participants and retirees count, dependents don’t.
You pay claims as they happen, with specific and aggregate stop-loss limiting large losses and a third-party administrator running the plan. In exchange for claims risk you get data, control and, generally, freedom from state insurance mandates and premium taxes.
GLP-1 coverage decisions, specialty drugs and formulary changes can move a renewal more than medical trend. On self-funded plans, pharmacy contract terms matter too.
Enrollment platforms, payroll deduction feeds and eligibility files replace spreadsheets. We help you pick the right setup with our partners.
A real market check compares fully insured, level funded and self-funded on the same census, not just three fully insured quotes.
Gag clause attestation every December 31, the RxDC report every June 1, Medicare Part D notices before October 15, and ACA reporting each year.
| Fully insured | Level funded | Self-funded with stop-loss | |
|---|---|---|---|
| Cost certainty | High: a fixed premium | High month to month; renewal follows claims | Lower: claims vary month to month |
| Savings potential | Lowest | Moderate, with a possible refund depending on the plan’s terms | Highest over time for a stable group |
| Claims risk to the employer | None | Capped by stop-loss | Capped by stop-loss, with more exposure |
| Data you receive | Limited | Regular claims reporting | Full claims data |
| Employer workload | Lowest | Low to moderate | Highest, shared with an administrator |
Sources: U.S. Department of Labor: Form 5500 series; CMS: gag clause prohibition compliance attestation; CMS: prescription drug data collection (RxDC); KFF 2025 Employer Health Benefits Survey.
An example for a January 1 plan year. A same-funding carrier change can run shorter.
Growing past 250? See employee benefits for 250 to 1,000+ employees. Also the large group hub, the benefits broker RFP guide, how we’re paid and how we handle your data.
Look at four things: how stable your claims have been, how much cash-flow variation you can absorb, whether you want the data and plan-design control, and the cost of stop-loss and administration for your group. We model it against fully insured and level funded on the same census before recommending anything.
Insurance for the employer on a self-funded or level-funded plan. Specific stop-loss caps what you pay for any one person’s claims in a year; aggregate stop-loss caps your total claims. The contract terms, like the deductible level and how claims incurred late in the year are handled, matter as much as the price.
Insured welfare plans generally file once they have 100 or more participants at the start of the plan year. Participants are covered employees, former employees on COBRA and retirees, not dependents. A plan that holds money in a trust or separate fund, which some self-funded and level-funded arrangements do, can owe a filing below 100. Your administrator or a compliance partner prepares it; we keep the date.
Decide your GLP-1 coverage policy deliberately, review formulary and tier changes at each renewal, and, on self-funded plans, look closely at pharmacy benefit contract terms. Pharmacy is usually the fastest-growing part of the renewal.
Often, yes, through a broker of record letter, without changing your plan. Carrier rules and timing vary, so we confirm them before anything is sent. See the broker RFP guide for how to compare advisers.
Plan on 150 to 180 days before your effective date if you might change funding, and at least 120 days for a carrier change on the same funding model.
Send your renewal and plan details. Within 5 business days of receiving them, you get a written review and a recommendation on whether a full market check is worth it.
The review is advisory. It is not a carrier quote, an actuarial opinion or a guarantee of savings.