By Jennifer Schaefer, MBA, ChFC, CLU, RHU, REBC, SHRM-SCP Founder & CEO, JS Benefits Group | Forbes Business Council Contributor | Co-Host, Executive Leaders Radio
For years, many mid-market employers have approached healthcare benefits the same way: wait for the renewal, review the premium increase, negotiate where possible, and decide whether to absorb the additional cost or shift more of it to employees.
But that process is beginning to look increasingly outdated.
The more important question isn’t simply:
“How much will our health insurance cost next year?”
It’s:
“Is our health plan funding strategy still the right one for our business?”
That question was at the center of my Forbes Business Council article, Why Healthcare Benefits Have Become A Retention Strategy Instead Of A Line Item.
Now, that perspective has received additional attention from Insurance Business, which published Most mid-market employers have never evaluated their health plan funding on August 11, 2026.
The article specifically identifies me as the Founder and CEO of JS Benefits Group and references my Forbes Business Council analysis regarding the need for mid-market employers to evaluate whether their health-plan funding structure still makes sense.
This conversation matters because healthcare benefits are no longer simply an annual insurance renewal decision. For many employers, they are a significant financial expense, a workforce strategy, and an important part of employee retention.
The Funding Question Most Employers Aren’t Asking
One of the biggest challenges I see with employer-sponsored healthcare is that businesses often focus heavily on the renewal rate without stepping back to evaluate the structure underneath it.
A fully insured health plan can provide predictability and simplicity. The carrier assumes the claims risk, and the employer pays a predetermined premium.
But that doesn’t necessarily mean it is the most efficient funding arrangement for every employer.
Depending on the company’s size, demographics, claims history, cash flow, risk tolerance and objectives, other strategies may deserve consideration.
These can include:
Fully insured health plans Level-funded health plans Self-funded health plans Group captive arrangements HSA-compatible plan designs Alternative healthcare cost-containment strategies
The point isn’t that every employer should move to a self-funded or level-funded plan.
The point is that employers should know why they are in the funding arrangement they’re in.
JS Benefits Group works with employers to evaluate benefit plan design and healthcare cost management alongside alternative funding strategies, including self-insured and captive approaches.
Why This Matters More Now
Insurance Business highlighted an important trend from the Kaiser Family Foundation’s 2025 Employer Health Benefits Survey: 80% of covered workers at large companies are enrolled in self-funded plans, compared with 27% at firms with 10–199 employees.
That difference raises an important question for mid-market employers:
Have you actually evaluated whether your current funding model makes sense for your company?
If the answer is no, the next renewal may be the wrong time to start.
A proper analysis can require time to obtain claims information, evaluate plan performance, model alternatives and understand the potential financial implications.
That’s why I encourage employers to start the conversation months before renewal, rather than waiting until a carrier presents the next increase.
Insurance Business also reported that KFF’s 2025 survey found 37% of covered workers at firms with 10–199 employees are enrolled in level-funded plans.
The funding landscape is changing. Employers need to understand what those changes mean for their own organizations.
Level-Funded Plans Have Changed the Conversation
Level-funded health plans have become an increasingly important option for employers that want more predictability while exploring an alternative to traditional fully insured coverage.
A level-funded arrangement generally combines:
A fixed monthly payment Claims funding Stop-loss protection Greater visibility into claims Potential opportunities when claims perform favorably
But level-funded plans aren’t automatically better.
The right question is whether the arrangement fits the employer’s claims experience, workforce, financial objectives and risk tolerance.
That’s where an experienced employee benefits consultant can add significant value.
Employers should evaluate the numbers rather than assume that one funding model is appropriate for everyone.
Self-Funding Requires More Than Looking at Premiums
Self-funded health plans can provide employers with greater visibility and control over healthcare spending.
But they also require a deeper understanding of claims risk.
Employers considering self-funding should evaluate factors such as:
Claims history: What does the company’s historical utilization actually look like?
Cash flow: Can the organization comfortably manage claims funding?
Stop-loss protection: What protection is available against large or catastrophic claims?
Plan design: Can the employer redesign the plan around the needs of its workforce?
Data: Does leadership have access to meaningful claims information?
Risk tolerance: Is the organization prepared for variability in claims?
The objective isn’t to move away from insurance simply because an alternative exists.
The objective is to make the funding decision intentionally.
JS Benefits Group specifically helps employers evaluate self-insured strategies and claims data as part of a broader healthcare cost-management approach.
The CFO Belongs in the Benefits Conversation
Healthcare benefits can represent one of the largest recurring expenses on an employer’s income statement.
That makes benefits strategy more than an HR issue.
It is a financial strategy, workforce strategy and retention strategy.
CFOs should be asking:
What is driving our healthcare costs? What are our claims telling us? Have we benchmarked our plan? Are we receiving enough value from our current carrier? Have we evaluated level-funded or self-funded alternatives? What would our healthcare costs look like under different plan designs? Are our employees actually using and understanding the benefits we’re paying for? How are our benefits affecting recruitment and retention?
These questions can change the conversation from:
“How do we get through renewal?”
to:
“How do we build a better healthcare strategy?”
That is a very different conversation.
Healthcare Benefits Are Also a Retention Strategy
This is where my Forbes article connects directly to the funding discussion.
Healthcare benefits aren’t simply another expense on a company’s budget.
Employees experience those benefits personally.
They experience:
Deductibles Copays Out-of-pocket maximums Prescription costs HSA contributions Provider networks Mental health benefits Wellness resources Benefits communication
A company can spend significantly on benefits and still have employees who don’t understand or value what they’re receiving.
In my Forbes Business Council article, I discussed why healthcare benefits increasingly belong in the broader conversation about employee retention and workforce strategy, rather than being treated solely as an annual insurance expense.
That perspective is also reflected in my Forbes Business Council profile, which identifies my work around employee benefits, HR consulting, leadership and workforce strategy.
What Employers Should Do Before Their Next Renewal
I recommend that employers start with an evaluation—not a predetermined solution.
1. Review Your Claims Data
Don’t make decisions based solely on the renewal percentage.
Understand what is actually driving healthcare spending.
2. Benchmark Your Current Plan
Look at your contributions, deductibles, out-of-pocket exposure, plan design and overall costs compared with appropriate benchmarks.
3. Evaluate Your Funding Model
Ask whether fully insured, level-funded, self-funded or another arrangement is appropriate for your organization.
4. Model Multiple Scenarios
Don’t evaluate only one alternative.
Compare potential costs, risks and employee impact under multiple strategies.
5. Bring HR and Finance Together
The best benefits decisions happen when HR, finance and executive leadership are looking at the same information.
6. Start Early
The biggest mistake is waiting until the renewal arrives.
A strategic benefits review should happen well before the renewal deadline.
The Bigger Opportunity for Mid-Market Employers
The healthcare market is changing.
The employers that simply react to their annual renewal may find themselves continually negotiating against a number they didn’t create.
The employers that understand their claims, evaluate their funding structure and connect benefits to workforce strategy have an opportunity to take a different approach.
Healthcare benefits should be managed—not merely renewed.
And for many mid-market employers, the first step isn’t changing the plan.
It’s asking a question that may never have been asked before:
“Have we actually evaluated whether our current health plan funding strategy is right for us?”
That conversation could be one of the most important benefits decisions your company makes this year.
About Jennifer Schaefer
Jennifer Schaefer, MBA, ChFC, CLU, RHU, REBC, SHRM-SCP, is the Founder & CEO of JS Benefits Group, an employee benefits and HR consulting firm specializing in group health insurance, self-funded and level-funded health plans, healthcare cost management, ACA compliance, corporate wellness, employee retention and workforce strategy.
Jennifer is a Forbes Business Council Contributor and Co-Host of Executive Leaders Radio, where she focuses on leadership, workforce strategy and the Future of Work.
Her Forbes Business Council article, Why Healthcare Benefits Have Become A Retention Strategy Instead Of A Line Item, was published July 2, 2026. Forbes identifies Jennifer as the Founder & CEO of JS Benefits Group and lists her focus areas as employee benefits, HR consulting, leadership and workforce strategy.
Insurance Business subsequently referenced Jennifer’s Forbes analysis in its August 11, 2026 article on mid-market health-plan funding.
