For CEOs of fully insured companies
Another double-digit renewal. And no one can tell you why.
You asked your carrier to explain the increase. You got "trend," "large claims," and a number. Fully insured renewals are built to be hard to question, and every year you pay more for less clarity. That model is not sustainable for a growing company.
- Enrolled employees
- 165
- Current annual premium
- $2,290,000
- Renewal annual premium
- $2,715,940
Basis: medical trend, experience, pooling, plan adjustments.
of M.E. Wilson's employee benefits business is self-funded.
in Florida for business written in the largest employee benefits captive in the country.
M.E. Wilson has served Florida employers for more than a century.
Sound familiar?
Fully insured renewals are hard to question.
The carrier holds the data and sets the rate. You get a number to accept.
- The renewal lands late.Weeks before your effective date, with little time to do anything but sign.
- The explanation is vague."Trend" and "claims experience," with no claims detail you can actually check.
- A good year isn't yours to keep.When your claims come in low, those unused dollars don't automatically come back to your company.
- The only levers left hurt people.Higher deductibles, higher payroll deductions, and benefits that make hiring harder.
Checking is not switching
Loyalty is good. Checking your options is better.
You can like your broker and still want a second set of eyes. Many fully insured renewals are never compared against a self-funded option. A second opinion costs nothing, and you don't have to change anything to get one.
Why is our premium going up?
Is your health plan a black box?
You know what you pay. But do you know where the money goes?
Fully Insured:
One Number
- Network?
- Admin?
- Pooling?
- Carrier profit?
- Claims?
Self-Funded:
Every Dollar Visible
With fully insured coverage, you see one number. You don't see what's inside it. Self-funding opens the box. You see every dollar, and the claims dollars you don't spend stay with you.
And in a bad year? Stop-loss insurance caps what you pay on any single large claim and on your total claims for the year. In a captive, that protection is shared with other mid-sized employers, so one bad year does not land on you alone.
Here is what's packed inside a fully insured premium
Pooling and risk charges
A charge to cover other employers' large claims. You pay it whether or not you had any.
Carrier admin and profit
Federal rules let a large group carrier keep up to 15 cents of every premium dollar for overhead and profit.
The money you didn't spend
If your claims come in under projection, that surplus isn't returned to you. Medical loss ratio rebates exist, but they're calculated across the carrier's whole block of business, not your company's own claims.
Before you sign
Five questions to ask your carrier and broker
Ask your carrier
- What specific claims drove this increase, and can we see the detail?
- How much of our premium is pooling, admin, and carrier margin?
- If our claims came in lower than projected last year, where did that money go?
Ask your broker
- How many of your clients are self-funded?
- Has anyone modeled what our plan would cost self-funded?
The cost of staying put
What will fully insured cost you over the next five years?
Enter your own numbers. This is simple math on your premium, not a sales estimate.
What self-funding opens up
Self-funding is more than negotiating a number.
You need a consultant who has done it many times. The structure, the vendors, and the execution decide whether you save money or trade one problem for another. We look at every option, and you choose what fits your company and your people.
Pharmacy carve-out
Move your pharmacy benefit to a transparent pharmacy benefit manager and see what every drug actually costs.
Reference-based pricing, as a choice
Offer a dual option: employees pick a traditional network plan or a plan that pays providers a fair, published benchmark. No one is forced into it.
Stop-loss through the captive
Protection against a bad claims year, shared with other mid-sized employers instead of carried alone.
Your claims data
See what is driving cost, month by month, so you can manage it instead of just paying it.
A broker quotes price. A consultant builds strategy. Our expertise is knowing which vendors fit your company and executing it properly.
The Renewal Second Opinion
What happens on the call
Book 20 minutes
Tell us about your plan and your last few renewals. No documents needed.
We assess fit
Based on your size, renewal history, and goals, we tell you whether self-funding deserves a deeper analysis.
You decide the next step
If it's worth a closer look, we securely request your census and renewal and model your options, including your worst case in dollars. If it isn't, we'll say so.
Questions CEOs ask
Before you book
Isn't self-funding too risky for a company our size?
That is the right question. A captive pools stop-loss protection with other mid-sized employers, so one bad year does not land on you alone. We show you your worst case in dollars before you decide.
We like our current broker. Do we have to switch?
No. The call is a second opinion on your renewal. You leave with information, and what you do with it is your decision.
Will our employees notice a change?
In many cases employees keep a familiar network and ID card experience. We cover what would and would not change for your people on the call.
When should we start?
Three to six months before your renewal date gives you real options. If you renew 1/1, now is the time.
What does the second opinion cost?
Nothing. It is 20 minutes with a consultant who works on self-funded plans every day.
Who you'll talk to
Eric Papp
VP of Employee Benefits Consulting at M.E. Wilson, Tampa. Eric works with Florida employers with 150 to 500 employees who are tired of renewals they can't control.
His work starts with a question most fully insured companies have never been asked: what would your plan cost if you funded it yourself and kept what you didn't spend? Eric is the author of Leadership by Choice (Wiley) and Manage Promises, Not People, spoke at SHRM's 2026 national conference, and is a graduate of the University of Notre Dame.
Our goal is simple
"We work for you, not the carriers."
Get a straight answer
Find out if self-funding deserves a closer look.
Book a 20-minute Renewal Second Opinion. You'll leave knowing whether self-funding is worth analyzing for your company and what the next step would be.
- 20 minutes, by phone
- No cost and no obligation
- No documents needed to start
Eric Papp, VP of Employee Benefits Consulting, M.E. Wilson