How much can a self-funded employer save on plan cost?

20 to 30% of plan cost is typically recoverable at self-funded employers, made up of reference-based pricing at 15 to 30% off facility cost, payment integrity returning 1 to 1.5% of claims, dependent eligibility audits at 3 to 8% of plan cost, captive structures returning 30 to 40% of the carrier spread, and transparent pharmacy contracts at 15 to 25% off Rx.

Does this replace our third-party administrator?

No. Save with Benefits is not a third-party administrator and works alongside whoever administers the plan. Several levers, including payment integrity, eligibility audits and pharmacy contract terms, are invisible to members entirely.

Is there savings left at an employer with a sophisticated benefits team?

Almost always. Fraud, waste and abuse runs 3 to 10% of spend industry-wide, and dependent eligibility audits return 3 to 8% of plan cost even at organizations with mature governance. It is a function of adjudicating millions of claims at speed, not a comment on the benefits team.

1,000+ EMPLOYEES · SELF-FUNDED · DAY-1 ROI

You own the risk. Do you own the savings?

Q: Is reference-based pricing worth the member friction?

Reference-based pricing prices claims against a defensible benchmark instead of a network discount, typically 15 to 30% off facility cost. Balance-billing exposure is handled by an advocacy team that defends any provider dispute on the member's behalf. Employers not ready for full RBP can capture much of the benefit through cash-pay carve-outs on planned procedures.

20 to 30% of plan cost is already yours. Bring us your goals and we'll craft the path to negative trend, keeping every dollar and every claim.

THE SELF-FUNDED PARADOX

You took on the risk. What did you get for it?

Going self-funded was supposed to mean control. Then the network discount stayed opaque, the pharmacy contract stayed sealed, and the claims file arrived too late to act on.

You carry the volatility. The savings that were supposed to come with it are still sitting in places nobody has opened.

The risk is already yours. The upside should be too.

WHAT'S RECOVERABLE

20 to 30% of plan cost you already own

$10 to $20M per Fortune 50 engagement, in 6 months

3 to 10% of spend lost to fraud, waste and abuse

You keep the claims file and every dollar saved

WHERE THE 20 TO 30% SITS

Which of these has been opened?

Each stands alone or stacks. Stacked, they produce negative year-over-year trend rather than a smaller increase.

Reference-based pricing (RBP)

15 to 30% off facility cost, benchmarked and defensible, with balance-bill advocacy defending the member so nobody is left in the middle.

Payment integrity

Fraud, waste and abuse runs 3 to 10% of spend. Bill review and overpayment recovery return 1 to 1.5% of claims, invisible to members.

Captive and risk layer

30 to 40% of the carrier spread returned, plus surplus. Stop-loss stops being a cost centre and starts being an asset.

Centres of excellence

Planned surgery at bundled prices: 45% and about $16,000 per case, with better outcomes than the local default.

Specialty and GLP-1 sourcing

Pass-through pharmacy with 100% rebate return, plus carve-outs on the categories driving your trend hardest.

Dependent eligibility audits

3 to 8% of plan cost, typically. Nobody loses coverage they're entitled to; the plan stops covering people it never owed.

YOU ALREADY HAVE THE EVIDENCE

What is your claims file telling you?

A handful of conditions and a handful of facilities drive most of your spend. You own that data. What's usually missing is someone whose job is to read it against every available lever rather than against one product line.

We built the health economics teams at the largest payers. We know where to look.

WHAT BENEFITS LEADERS ASK

The questions you're already thinking.

Who administers this? We already have a TPA.

Is reference-based pricing worth the member friction?

We have a sophisticated benefits team. Is there really anything left?

What does implementation cost us in internal resource?

What would negative trend be worth?

Bring us your challenges. Tell us your goals. We'll model your actual claims and hand back a number, at no cost.

See your savings