Self-Funded Employers
Self-funded, without the claims engine.
You chose self-funding for control. OffPlan delivers it.
You are already paying for care directly. But your TPA, your PPO network, and your PBM are still processing that care through an insurance infrastructure built for someone else's margins. Every routine doctor visit generates a claim. Every claim feeds admin overhead. Every layer takes a cut. OffPlan replaces that infrastructure for the 80% of care that never needed it.
The Real Problem
The problem is not self-funding. It is what sits inside the plan.
Self-funded employers assume they have control. But most are still running care through vendors who profit from volume and complexity, not outcomes.
Your TPA
processes every claim, routine or catastrophic, at the same per-claim fee.
More claims, more revenue. No incentive to reduce volume.
Your PPO Network
reprices at 200 to 350% of Medicare.
A knee MRI that Medicare reimburses at $442 costs your plan $1,200 to $3,000. That spread is someone else's profit margin, not your employees' health.
Your PBM
earns on the spread between what your plan pays and what the pharmacy receives.
Hidden rebates flow to them, not back to you. The formulary is designed around their margins, not your employees' health.
The Pattern
Nobody in that stack has a financial incentive to lower your costs.
That is not a conspiracy. It is their business model. OffPlan replaces it with a stack where every partner is aligned with the same objective: lower cost, better care, full transparency.
The Structure Change
How OffPlan rebuilds the stack.
We do not bolt new vendors onto a broken structure. We replace the structure for the care that does not belong in it.
Primary Care + Specialist Care (80% of spend)
Primary care through physician-owned practices. 500 to 600 patient panels. Same-day access. Chronic disease management. Specialist referrals coordinated through a curated cash-pay network at pre-negotiated transparent rates. Transparent pharmacy through an aligned PBM. No claims generated. No prior authorizations. No PPO repricing. No billing friction. Fixed monthly cost.
Intermediate Event Protection
Protection for unexpected events below the major-event threshold. ER visits, urgent care, injuries, minor procedures. Hospital indemnity and accident insurance. HSA-compatible.
Major Event Protection
Stop-loss through a carrier selected for this model, not bundled from a legacy ASO product. Specific and aggregate protection. TPA administers claims only for true high-cost events: hospitalizations, major surgery, serious medical events. This is the only layer that generates claims. This is what insurance was designed for.
A Common Misunderstanding
This is not a DPC practice bolted onto your plan.
Any DPC doctor can give your employees unlimited visits and same-day access. That is worth $75 to $125 a month. OffPlan delivers that physician inside a direct care platform that a standalone practice cannot build:
Population health analytics
Visibility into what your HR and finance teams what is happening across your employee population. Utilization patterns. Chronic disease prevalence. Claims avoidance tracking. ER diversion rates.
Predictive risk stratification
Identifies which employees are trending toward high-cost events before they get there. The diabetic whose A1c is climbing. The pre-hypertensive employee who missed follow-ups.
Specialty care coordination
Curated cash-pay network. Rate negotiation, scheduling, and payment via benefit card. eConsults to deflect unnecessary in-person referrals entirely.
A dedicated account manager
For your HR team. Quarterly business reviews. Enrollment management. Advisor coordination. Not a call center.
Data that earns better renewal pricing
Clinical and utilization data compiled into evidence your advisor uses at renewal. The bridge between "our employees are healthier" and "our carrier prices accordingly."
The physician delivers the care. The platform delivers the results.
The CFO Question
Where the risk actually sits.
Self-funded employers do not eliminate risk. They manage it. OffPlan changes where that risk lives and who profits from it.
You are not waiting for claims savings. You are preventing claims from happening in the first place.
| Traditional Self-Funded | OffPlan |
|---|---|
| Variable claims. TPA adjudicates. | Fixed cost. No claims. No variability. |
| PPO repricing at 200 to 350% of Medicare | Cash-pay at transparent, pre-negotiated rates |
| Run through claims. Drives volatility. Hits stop-loss in bad years. | Hospital indemnity and accident insurance layer. HSA-compatible. Reduces stop-loss exposure. |
| PBM spread pricing. Hidden rebates retained. | Transparent PBM. No spread. 100% rebate pass-through. |
| TPA paid per claim. More claims = more revenue. | TPA handles catastrophic only. 80% fewer claims to process. |
| Stop-loss (often bundled with carrier ASO) | Stop-loss through aligned carrier. Better data, better pricing. |
The Renewal Math
Why stop-loss carriers price this differently.
Carriers price risk based on what they see in the claims data. When OffPlan physicians manage the 80%, the data changes:
ER Utilization
ER utilization drops.
The employee with the earache at 10pm texts their physician instead of driving to the ER. The $3,000 to $8,000 ER visit that was never medically necessary never happens.
Chronic Conditions
Chronic conditions stabilize.
The diabetic whose A1c is climbing gets caught in a routine 45-minute visit, not after a hospitalization. The pre-hypertensive employee never becomes hypertensive.
Specialist Costs
Specialist costs drop.
Referrals route through curated cash-pay providers at transparent rates. No PPO markup. No facility fees. No surprise bills. eConsults deflect unnecessary in-person visits entirely.
Catastrophic Events
Catastrophic events become rarer.
When care is managed upstream, fewer conditions escalate to the point where they generate a high-cost claim. The stop-loss layer gets cleaner every year.
The Underwriting Advantage
This is not lower risk because of plan design tricks or network restrictions. It is lower risk because the care model changes outcomes before they reach the claims system.
That is a difference carriers can see in the data, and it is why stop-loss pricing improves year over year.
Side by Side
Traditional self-funded vs. OffPlan.
The structural difference at a glance. Same employer. Same group. Different model underneath.
| Traditional Self-Funded | OffPlan |
|---|---|
| Every service generates a claim | 80% of care never enters the claims system |
| TPA adjudicates all care | TPA handles catastrophic only |
| PPO repricing at 200 to 350% of Medicare | Cash-pay specialists at transparent rates |
| PBM earns on spread and retained rebates | Transparent PBM. Full rebate pass-through. |
| Care is unmanaged until claims arrive | Care is managed upstream by dedicated physicians |
| Carrier, TPA, PBM all profit from volume | Every partner aligned on outcomes |
| You manage a claims system | You manage healthcare directly |
The Engine
Reclassify®. The analytical layer underneath.
Not every TPA, PBM, or stop-loss carrier is built to work with this model. Before any of this is real for your group, OffPlan runs your current spend through Reclassify.
The claims analysis layer that powers the OffPlan model.
Reclassify maps where your dollars actually go. It identifies what moves out of the claims system entirely, what gets repriced through curated cash-pay, and what genuinely belongs in stop-loss. The output is the residual figure your group actually needs to fund.
For self-funded employers, Reclassify produces something specific: a partner-by-partner read on your existing stack. If you are self-funded through a large carrier's ASO product with a bundled TPA and a PBM that uses spread pricing, those partners may be part of the cost problem, not the solution. Reclassify tells you what works, what needs to change, and what we keep.
Where 80% of care runs outside the claims system, we will recommend a TPA that can handle that. If your PBM retains rebates and earns on spread, we will recommend a transparent alternative. The goal is not to replace everything. It is to replace what is working against you.
Keep what works. Replace what doesn't.
Let the data prove the model. Then decide how far you want to go.
OffPlan works with your advisor, not around them.
OffPlan is not insurance. We work alongside your advisor to restructure the benefits stack, not around them. We provide co-selling support, ROI modeling, and the clinical data that makes the renewal conversation easier.
Stop defending the increase. Start changing the math.
Side-by-side cost model using your current plan data. No commitment. Just the math.
Request a Custom Cost Analysis