Fully Insured Employers
You are paying the most for healthcare and getting the least from it.
Fully insured is the most expensive way to deliver care that your employees are afraid to use.
Every year, your carrier sends a renewal with a higher number. You negotiate. Maybe you shop carriers. Maybe you raise deductibles. The result is the same: your employees pay more, use care less, and the next renewal is worse. You have no visibility into where the money goes because the carrier does not show you. You are buying a product designed to profit from your inability to see what it costs.
Already on a high-deductible plan? The HDHP path is a focused walkthrough for fully insured employers with HDHPs, including the 2026 HSA + DPC rules, employee experience, and funding mechanics. See the HDHP path →
The Real Cost
What fully insured is actually costing you.
It is not just the premium. It is everything the premium hides.
1. 7 to 10% annual increases.
Not anomalies. That is the model working exactly as designed. You are in a community-rated pool with every other employer. Your good claims experience subsidizes someone else's bad year. The carrier's pricing model is built to compound, not to reward you.
2. Employees afraid to use the benefit.
High deductibles mean your employees avoid care until something becomes an emergency. The $2,000 to $5,000 deductible you added to keep premiums manageable is now a barrier between your employees and a doctor. That is not healthcare. That is a coupon with a catch.
3. No visibility.
You do not see claims data. You do not know which conditions are driving cost. You cannot manage what you cannot see. Your carrier can. They just do not share it with you.
4. PBM margins built into the premium.
Your carrier's pharmacy benefit manager earns on spread pricing and retains rebates. Those costs are baked into your premium but never itemized. You are paying for someone else's margin on every prescription.
5. Or worse: you cannot offer insurance at all.
For many SMBs with 5 to 25 employees, fully insured premiums are simply unaffordable. You lose candidates to larger companies because you cannot offer a health benefit. Your employees go uninsured or buy individual plans. You absorb the productivity cost of a workforce that avoids the doctor.
Either way, you are paying for access to a system your employees avoid.
The Structure Change
OffPlan replaces the structure, not the protection.
The 80/20 problem is worst in fully insured plans because you are paying carrier margin, carrier admin, and carrier profit on every doctor visit, every lab, every prescription. OffPlan removes all of that for the 80% of care that never needed insurance. Real protection stays for the 20% that does.
Primary Care + Specialist Care (80% of spend)
A dedicated physician for every employee. Same-day access. 45-minute visits. Chronic disease management. Specialist referrals through a curated cash-pay network. Transparent pharmacy. No copays. No deductibles. No claims. No carrier involvement. Fixed monthly cost that does not increase at 7% a year.
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 protection for hospitalizations, major surgery, and serious medical events. This is what insurance was designed for: rare, expensive, unpredictable events. This is the only layer that involves insurance. This is the only layer exposed to annual renewal.
The Platform
This is not just a doctor. It is a platform.
You could contract with a DPC practice for $75 to $125 a month and get your employees unlimited visits. But that does not change your renewal. It does not coordinate specialist care. It does not give you data. It does not manage your population's health. OffPlan does all of that.
Population health analytics
For the first time, you see what is happening across your employee population. Utilization patterns. Chronic disease prevalence. ER diversion. Claims avoidance. Data you have never had because your carrier never shared it.
Predictive risk stratification
Which employees are trending toward high-cost events. The platform surfaces it. The physician acts before it becomes a claim.
Specialty care coordination
Pre-vetted, pre-priced cash-pay providers. No PPO markup. No facility fees. No surprise bills. eConsults to avoid unnecessary referrals. The employee shows up and pays $0.
A dedicated account manager
Quarterly business reviews with your HR team. Enrollment management. Advisor coordination. A real person who owns your relationship.
The data to prove it at renewal
After 12 months, you have clinical and utilization evidence your advisor can use to negotiate level-funded or self-funded terms. That data is worth more than the membership itself because it is what breaks you out of the fully insured cycle permanently.
The physician delivers the care. The platform delivers the results.
The Employee Experience
What changes for your employees.
This is not a downgrade. It is the opposite.
Your employees get better care than they have ever had. And you pay less than you are paying now.
| Today (Fully Insured) | With OffPlan |
|---|---|
| $2,000 to $6,000+ deductible before insurance pays | $0 deductible for primary care. No copay. No claim. |
| 3-week wait. 12-minute visit. See a stranger. | Same-day access. 45-minute visits. A doctor who knows their name. |
| Avoid the doctor because it costs too much | Use the doctor because it costs nothing |
| ER for after-hours care. $3,000 to $8,000 bill. | 24/7 access to care. Urgent needs handled day or night. |
| MRI: $1,200 to $3,000 after deductible | MRI: ~$350. Employer-funded benefit card. $0 to the employee. |
| Surprise bills. Balance billing. Confusion. | Transparent pricing. No surprises. No bills in the mail. |
How You Get Started
Three paths out. Pick the one that fits your group.
Your funding structure does not have to change overnight. Or it can. Some employers want immediate premium relief. Some want a 12-month runway to build the data. Some want to take the structural step at renewal and skip the runway entirely. We support all three.
Path A · Save Now
Switch to HDHP + OffPlan.
Move to a high-deductible plan as part of this transition. Premium drops immediately. OffPlan goes underneath your existing HDHP and HSA structure to handle the 80% of care employees actually use day to day.
Federal law now allows your employees to keep contributing to their HSA while you provide the OffPlan membership. This is the path most carriers and brokers are not yet talking about.
Path B · Build the Case
Layer OffPlan now. Transition at renewal.
Keep your existing fully insured plan in place. Add OffPlan as a supplemental healthcare services contract. No carrier approval needed. No change to your existing benefits.
Your employees start using their OffPlan physician for routine care. Claims utilization drops. After 12 months, you have the data your advisor needs to negotiate better fully insured renewals, level-funded structures, or self-funded transitions at next renewal.
This is a 12-month investment, not immediate savings. The payoff comes when you have a year of claims data proving the model works for your population.
Path C · Convert at Renewal
Take the leap. Reclassify de-risks the conversion.
Most fully insured SMBs in the 5 to 250 employee range are never offered self-funded as an option. The fully insured renewal cycle is the default they are left in.
Path C is the direct alternative. At your next renewal, you do not take the carrier renewal. You convert from fully insured to a self-funded structure built and operated through OffPlan. Reclassify analyzes your group's actual spend pattern, separates the catastrophic events from the routine and predictable, and sizes your claims fund at the minimum liquidity reserve, not the inflated expected-claims figure your premium has been built around.
You fund the residual. OffPlan delivers primary care, chronic care, specialty access, and pharmacy directly. Stop-loss is placed with a licensed carrier. Your CFO has a number they can plan to.
A Different Audience
For employers who cannot offer insurance today.
If you are a 10-person company that has never been able to afford group health insurance, OffPlan changes the math entirely. You are not choosing between a $750+ PEPM fully insured plan and nothing. You are choosing between nothing and a direct care platform that covers 80% of your employees' healthcare needs at a fraction of that cost, with catastrophic coverage layered on top.
Your employees get a dedicated physician, same-day access, and $0 primary care. You get a health benefit that makes you competitive with employers three times your size. And because the care layer is a services contract and not insurance, you are not subject to the same underwriting and minimum participation requirements that priced you out of the market in the first place.
The Multi-year Picture
Where it goes.
OffPlan is a structural change. Path A and Path B follow a 24 to 36 month arc: the first year buys you data, the second year buys you leverage, by year three you make decisions about your benefits structure with real numbers instead of industry assumptions. Path C compresses that arc. Reclassify gives you the numbers up front, and the structural decision happens at the renewal you are walking into now.
Year 1
Layer OffPlan onto your existing fully insured plan (Path B), or switch to HDHP + OffPlan at next renewal (Path A), or convert directly from fully insured to a self-funded structure operated through OffPlan (Path C). Claims drop. Employee satisfaction goes up. You have data for the first time.
Year 2
Path A and Path B employers have 12 months of claims experience their advisor can use to negotiate better terms, evaluate level-funded structures, or model self-funded transitions. Path C employers are already there. Year 2 is for refining the funding model and reducing the residual.
Year 3+
You make structural funding decisions based on real data, not industry assumptions. The carrier is no longer the only one with the numbers. You are no longer on the renewal treadmill, regardless of which path you started on.
For Your Benefits Advisor
OffPlan works with your advisor, not around them.
OffPlan is not insurance. For Path A, we coordinate the HDHP transition and HSA setup. The premium base drops immediately. For Path B, the existing plan stays in place while claims data builds. At renewal, that data positions you to negotiate a transition to level-funded or self-funded terms. For Path C, Reclassify produces the funding analysis your advisor would otherwise build over 12 months of waiting, and we coordinate the conversion at next renewal directly. We never disintermediate the advisor relationship. We provide co-selling support, ROI modeling, and the clinical and actuarial data that makes the renewal conversation easier.
Stop paying more for less. Start the conversation.
Three paths, real numbers, your group. We will show you exactly what changes.
Schedule a 30-Minute Walkthrough