1. Discovery and data
Your goals, budget, current contracts and at least two years of claims and enrollment data, sent through a secure link.
Moran Insurance Group
Licensed Insurance Brokers
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863-270-9820
At this size the health plan is usually self-funded, run through contracts with an administrator, a stop-loss carrier and a pharmacy benefit manager, and governed like any other major spend. Here is what changes and how we work with companies your size.
Most large employers self-fund: 80% of covered workers at firms with 200 or more workers are in self-funded plans. The plan pays claims as they happen, a third-party administrator runs it, and stop-loss insurance limits large losses.
The work shifts from picking a plan to managing contracts, data and governance: stop-loss terms, pharmacy pricing, monthly claims reporting, and a documented decision process. Our team leads that work, with specialist partners for administration, stop-loss and pharmacy contracts.
Funding is usually self-funded with stop-loss. Fully insured and level-funded plans are still worth pricing for some groups, but most comparisons at this size are between administrators, stop-loss proposals and pharmacy contracts.
Compare the specific deductible per person, the aggregate attachment point for total claims, the contract basis (for example 12/15, which covers claims paid up to three months after the year ends), lasers on individuals, and renewal caps. A cheaper contract with a short run-out can cost more in a bad year.
On a self-funded plan, pharmacy benefit manager terms decide much of the cost: pricing guarantees, how rebates are handled, audit rights, and specialty and GLP-1 coverage rules.
Expect monthly claims reports, high-cost claimant reports and trend by category. That data is what lets you negotiate, change plan design and forecast the next year.
People who make discretionary decisions about the plan act as ERISA fiduciaries. A benefits committee with a set calendar and written decisions is the usual way to show a prudent process.
Form 5500, ACA reporting, the gag clause attestation every December 31, the RxDC report every June 1, Medicare Part D notices before October 15, and mental health parity: plans covering mental health and substance use disorder benefits must be able to produce a written comparative analysis of their treatment limits on request.
Your goals, budget, current contracts and at least two years of claims and enrollment data, sent through a secure link.
Where the money goes, what is driving trend, and whether your funding model, stop-loss level and plan design still fit.
We take the pieces that need testing to market through our partner network: administrators, stop-loss carriers and pharmacy benefit managers, as well as fully insured carriers when they fit.
A written comparison and recommendation your finance and HR leaders can approve and keep on file.
Contracts, plan documents, enrollment, employee communication and payroll feeds, with a check of the first months of claims and billing.
Claims, trend, high-cost cases and the compliance calendar, reviewed with you every quarter.
| Item | Why it matters | Who handles it |
|---|---|---|
| Stop-loss renewal | Deductible levels, lasers, contract basis and renewal caps move your worst-case cost. | Our team, with stop-loss partners |
| Pharmacy contract | Pricing guarantees, rebates and audit rights decide a large share of spend. | Our team, with pharmacy partners |
| Administrator performance | Claims accuracy, service and reporting quality. | Our team and your administrator |
| Plan design and contributions | Trend, employee cost share and the ACA affordability test. | Your committee, with our modeling |
| Compliance calendar | Filings, attestations, notices and parity documentation. | Your administrator and compliance partners; we keep the dates |
Companies this size often choose advisers through a formal RFP. Our benefits broker RFP guide lists 20 questions to ask every broker, with a scoring table, and we answer them in writing ourselves. See also how we work, how we’re paid and how we handle your data.
Sources: KFF 2025 Employer Health Benefits Survey; U.S. Department of Labor: understanding your fiduciary responsibilities under a group health plan; U.S. Department of Labor: mental health and substance use disorder parity; CMS: gag clause prohibition compliance attestation; CMS: prescription drug data collection (RxDC).
No. Most large employers self-fund, but a fully insured or level-funded plan can still fit a company with volatile claims, tight cash flow or little appetite for risk. We model the options on your census and claims before recommending one.
A higher specific deductible, or an exclusion, that the stop-loss carrier sets for one named person with a known high-cost condition, usually at renewal. A “no new laser” provision protects against new lasers at renewal, generally for a higher premium. Lasers are one of the terms we compare across stop-loss proposals.
Under ERISA, fiduciary status depends on what someone does for the plan, not their title. People who exercise discretion over the plan or its assets act as fiduciaries and must act in participants’ interest, prudently, and pay only reasonable plan expenses. A documented decision process helps you show that.
It is not required, but many larger employers use one: a small group from finance and HR that reviews the plan on a set calendar, records its decisions and the reasons, and approves major changes. We prepare the materials for those meetings.
Plan on 180 to 210 days before your effective date when you might change administrator, stop-loss carrier or pharmacy benefit manager. Renewals that only test the stop-loss market can run shorter.
Send your renewal or your stop-loss and administrator renewal notices. Within 5 business days of receiving them, you get a written review and a recommendation on what is worth taking to market.
The review is advisory. It is not a carrier quote, an actuarial opinion or a guarantee of savings.