Who is keeping the margin on your plan?

Level-funded gives you a fixed monthly cost while recovering the carrier margin and returning your claims data, usually 8 to 15% of premium. Self-funded gives you full control and every dollar of savings, but you carry the claims risk with a stop-loss layer above it. The 50, 100 and 250 employee marks are where the answer usually changes. We model both against your census first.

Because you can't manage what you can't see. Fully insured carriers keep your claims data, which means every renewal is a number you're asked to accept without evidence. Getting the file back is often worth more than the first year of savings, because it makes every subsequent decision an informed one.

A CHOICE Arrangement, previously known as an individual coverage health reimbursement arrangement or ICHRA, replaces the group plan with a fixed monthly allowance each employee uses to buy their own individual-market plan. It turns unpredictable trend into a capped budget line with zero renewal volatility, and it fits best when budget certainty is the priority or your workforce is geographically dispersed. The trade is network continuity. It is a form of defined contribution.

CMS and the SBA adopted the CHOICE Arrangement name on September 3, 2026. It was a rename only, so the rules, eligibility classes and affordability tests are unchanged, and IRS guidance and existing plan documents still say ICHRA.

Structural changes align to your plan year, but almost nothing else does. Pharmacy contract terms and payment integrity can start without waiting for the renewal. Cost-saving payroll bolt-ons are live in 30 to 45 days, fully managed. Most employers start those first and bring the structural conversation to the renewal already holding better numbers.