Level-Funded Employers
This is not a different plan. It is a different way to fund healthcare.
You moved away from fully insured. OffPlan makes that decision actually work.
You got out of the community-rated pool. Your claims experience started mattering. But every primary care visit, every chronic care check-in, every routine lab still generates a claim that counts against your funded level. OffPlan removes the routine 80% from the claims system entirely, leaving only true catastrophic risk to your carrier.
The Structure Change
How it actually works.
A traditional level-funded plan runs all care through the same claims pipe. OffPlan breaks that into three distinct layers, each funded differently, each with a different risk profile.
Primary Care + Specialist Care (80% of care)
Unlimited primary care, chronic disease management, care coordination, and specialist routing through cash-pay providers. Pharmacy through a transparent PBM. Fixed monthly rate. No claims generated. No variability. This is a services contract, not insurance.
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
Specific and aggregate stop-loss protection through licensed carriers. Employer retains risk up to the deductible. Carrier covers everything above it. This is where insurance belongs. This is the only layer exposed to annual renewal.
The Engine
Reclassify™. The analytical layer underneath.
Every level-funded employer arrangement starts here. 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 level-funded employers specifically, this matters because your funded level was set by your carrier based on expected claims. Reclassify™ shows you what your group actually costs once the routine 80% is removed. The number is meaningfully smaller. The volatility is meaningfully lower. The conversation with your stop-loss carrier at renewal is meaningfully different.
The components below are the structure. Reclassify™ is the math behind them.
A Common Misunderstanding
This is not a DPC practice added to your plan.
A standalone DPC doctor gives your employees unlimited visits and same-day access. 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 delivers that physician inside a direct care platform built to manage your entire population's health and produce the data that earns you better rates at renewal.
Population health analytics
Utilization patterns, chronic disease prevalence, claims avoidance tracking, and ER diversion rates. Not a patient portal. An employer-grade dashboard.
Predictive risk stratification
Which employees are trending toward high-cost events before they get there. The platform surfaces it. The physician acts on it.
Specialty care coordination
Pre-vetted, pre-priced cash-pay providers. Scheduling, payment, and results routing handled by the platform. eConsults to avoid unnecessary referrals entirely.
A dedicated account manager
Quarterly business reviews. Enrollment management. Advisor coordination. A named person, not a call center.
Renewal evidence packaging
Clinical and utilization data compiled into evidence your advisor uses to negotiate better terms. The data is what makes the renewal conversation change.
The DPC gives your employees a doctor. OffPlan gives them a doctor inside a system that manages your population's health, produces the data that earns better stop-loss pricing, and changes the renewal conversation.
The Renewal Math
Why your renewal gets better, not worse.
Carriers price risk based on what they see in the claims data. When OffPlan physicians manage the 80%, the claims data changes. Specifically:
ER Utilization
Reduced ER utilization.
Urgent needs handled same-day in the physician's office instead of a $3,000 to $8,000 ER visit.
Chronic Conditions
Chronic disease stabilization.
Diabetes, hypertension, and COPD managed proactively with 45-minute visits and direct physician access. Conditions stabilize instead of escalating.
Catastrophic Escalations
Fewer catastrophic escalations.
The chest pain that gets evaluated on Tuesday instead of ignored until Friday and handled in the ER. The pre-diabetic who never becomes diabetic.
Utilization Patterns
Predictable utilization patterns.
When 80% of care runs through a managed membership, the remaining 20% becomes more predictable, not less.
The Key Point
This is not lower risk because of plan design tricks. It is lower risk because the care model changes outcomes upstream.
That is a difference carriers can see in the data, and it is why the renewal conversation changes.
The CFO Question
Where the risk actually sits.
This is the question your CFO will ask. Here is the answer.
| Component | How it is Funded | Risk Profile |
|---|---|---|
| Primary care | Fixed monthly rate | No variability. Predictable cost. |
| Specialists + imaging | Employer-funded benefit card at cash-pay rates | Controlled. Transparent. Pre-negotiated. |
| Pharmacy | Transparent PBM | No spread pricing. No hidden rebates. |
| Gap events (ER, urgent care, injuries) | Hospital indemnity and accident insurance. HSA-compatible. | Voluntary insured layer. Carrier-priced. Reduces stop-loss exposure. |
| Catastrophic events | Stop-loss carrier | True insurance risk. The only variable. |
Traditional level-funded plans keep claims risk inside the system for all care. OffPlan removes most of that risk before it ever becomes a claim. That is the structural difference.
A Practical First Step
Start with the layer. Let the data decide.
You do not have to rip and replace. You do not have to convince your board on day one. You just have to be willing to test it.
Keep your plan. Add OffPlan. Watch your claims drop for 12 months. Reclassify™ gives you the analytical baseline up front. OffPlan delivers the care. The data tells you what to do next.
Then decide if you want to keep paying for both or just the one that's working.
You already moved out of fully insured. The next move is structural.
Share your group profile and we will return a modeled comparison that shows what gets removed from claims entirely, what gets repriced, and what is left to fund. We walk it through with you and your advisor on a 30-minute call.
Get a Custom Analysis