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Most employers paying carrier-set premiums never see where their health care dollars actually go. That blind spending compounds year after year, and it costs more than most HR teams realize.
Apex Benefits is Indiana’s largest independent employee benefits brokerage focused solely on group health, and we structure self-funded health plans that expose cost drivers, recover wasted spend and put your organization in control.
Self-funded health insurance works especially well for organizations with stable, medium-to-large employee populations and consistent cash flow, which describes most K-12 school districts, county and municipal governments and manufacturers Apex serves across the nation.
These organizations carry enough workforce size to spread risk effectively, and many already operate under budget constraints that make paying a carrier’s built-in profit margin an unnecessary cost.
Apex has held the Association of Indiana Counties endorsement since 2006 and serves more public-sector clients than any other independent benefits firm in the state.
With a self-funded plan, your organization pays actual claims costs instead of a carrier’s fixed premium, which bundles in administrative fees, profit margin and risk charges you never see itemized. Eliminating those layers is where the savings start.
Fully insured plans deliver a bill each month but no explanation for what’s driving it. Self-funded plans give your leadership team access to real claims data, so you can act on cost trends before they compound.
Carrier-controlled plans are built for the average workforce, not yours. Self-funded plans let Apex design coverage tiers, network structures and plan features around what your employees actually use.
In a fully insured arrangement, when your claims come in below projection, the carrier keeps the surplus. A self-funded plan means your organization retains those dollars, available to reinvest into reserves, richer benefits or other priorities.
Self-funded plans involve more moving parts than a standard carrier arrangement, including third-party administrators, stop-loss coverage, claims auditing and compliance oversight. Apex coordinates every piece so your HR team can focus on your people instead of plan mechanics.
Apex starts every self-funded health plan with a no-cost assessment of your current spend, workforce health data and benchmarking against comparable employers in your industry and region.
Our team then selects your third-party administrator, secures stop-loss coverage and layers in pharmacy benefits consulting and population health management to drive ongoing cost control. You get one accountable partner managing every component of your plan.
Self-funded plans work best for organizations with the consistent cash flow to pay claims directly as they occur, rather than a fixed monthly premium.
Self-funded health insurance works best for organizations with 100 or more employees, where workforce size creates enough claims volume to manage risk predictably.
Fully insured plans deliver a bill each month with no explanation for what’s driving it, while self-funded plans replace that opacity with real cost accountability.
Self-funded plans give your leadership team access to real claims data, so you can act on cost trends before they compound.
Carrier-controlled plans are built for the average workforce, not yours — a self-funded plan lets Apex design coverage tiers, network structures and plan features around what your employees actually use.
A self-funded health plan broker monitors claims data year-round to catch cost trends before they escalate, coordinating stop-loss coverage, claims auditing and compliance oversight along the way.
The most common concern employers raise about self-funded health insurance is exposure to catastrophic claims, and stop-loss insurance is what resolves it.
Specific stop-loss caps your liability on any single member’s claims, while aggregate stop-loss sets a ceiling on your organization’s total annual claims cost. Together, they give your self-funded health plan a financial floor so unexpected high-cost claims do not derail your budget.
Apex works with top-rated stop-loss carriers to structure coverage that matches your workforce’s actual risk profile, not a generic industry threshold.
The proof is in the outcomes. An Indiana township covering local government and fire department staff faced runaway medical claims costs that threatened their annual budget.
Apex restructured their self-funded health plan around high-cost claims management, saving the organization $2.5 million. In a separate engagement, an Indiana county moved to a reference-based reimbursement arrangement through Apex, saving over $3.5 million across six years and funding two employee premium holidays and employer-paid long-term disability.
A 235-person township of local government and fire department employees was facing runaway medical claims with no clear path to controlling costs. Over a five-year partnership with Apex, they saved $2.5M while the broader market trend climbed 37% over the same period.
A county government with 100 employees was watching health care costs climb against a capped revenue stream with no room to absorb increases. Apex moved them from a fully insured model to reference-based reimbursement — with no disruption to employee benefits — generating over $3.5M in savings across six years.
A self-funded health plan is an employer-sponsored arrangement where your organization pays employee medical claims directly as they occur instead of paying a fixed premium to a carrier. The employer assumes financial responsibility for claims and gains direct control over plan design and costs.
Your organization sets aside funds to cover anticipated employee medical claims, with a third-party administrator processing payments and stop-loss insurance capping your exposure. Apex manages the full structure so your HR team is not left coordinating it alone.
A fully insured plan charges a fixed premium regardless of your actual claims, and the carrier controls every aspect of plan design. A self-funded arrangement transfers that control to your organization, delivering claims transparency, customization flexibility and direct financial accountability.
Self-funded health insurance works best for organizations with 100 or more employees, where workforce size creates enough claims volume to manage risk predictably. Smaller employers may be better positioned for a level-funded plan, which offers similar cost advantages with a more predictable monthly structure.
A self-funded health plan broker designs your plan structure, selects your third-party administrator, negotiates stop-loss coverage and monitors claims data year-round to keep costs on track. Apex goes further by integrating pharmacy consulting and population health management into every plan we build.
Learn how to design an employee benefits program that controls costs, attracts talent and supports your workforce. A practical 5-step guide for mid to large employers from Apex Benefits.
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