Butcher & Associates Pensacola, FL
Self-funded · Pensacola mid-market

Self-funded health plan broker in Pensacola.

For Florida mid-market employers from roughly 100 to 300 lives. We model the TPA, stop-loss layers, PBM, and network rental as separate decisions, not a bundled product. Pensacola brokerage since 2012.

What this is

Self-funded, on the actual mechanics.

Self-funded means a Pensacola employer pays its employees' medical claims directly as they incur, plus an administrative fee to a third-party administrator, plus stop-loss reinsurance to cap catastrophic exposure. The employer assumes the year-to-year claim variability the carrier absorbs on a fully-insured plan, and in exchange keeps 100 percent of any claim-year surplus, holds the float on the reserves, and gets full transparency into claim data the carrier would never release on a fully-insured book.

The stack has five separable parts: the third-party administrator (TPA) that processes claims and runs the customer service line, the specific stop-loss carrier that caps cost per individual claimant, the aggregate stop-loss carrier that caps total annual claim spend, the pharmacy benefit manager (PBM) that runs the prescription drug program, and the network rental that determines which providers are in-network. Each is a separate decision with separate economics, and most of the cost-control levers live in how those decisions are made, not in which carrier badge is on the ID card.

For most Pensacola mid-market employers the question is not whether self-funded is theoretically possible — it is whether your specific claim run-rate, demographics, and cash-flow tolerance make the move worth the additional administrative load. That answer requires actual modeling against actual claim data.

How Butcher handles it

The five-vendor analysis.

Wil starts a self-funded feasibility study with twenty-four months of paid-claim history and your fully-insured renewal as the comparison baseline. We model the projected claim spend at your group's run-rate, layer in IBNR (incurred but not reported) reserves of roughly 8 to 15 percent of trailing monthly claims, and stack the specific stop-loss attachment ($50k to $150k typical) and aggregate attachment (120 to 125 percent of expected) on top so the catastrophic exposure is bounded.

From there the feasibility splits into RFP work across each vendor in the stack. We run TPA RFPs against national administrators (Aetna ASO, Cigna ASO, UMR, Meritain) and regional administrators that often quote sharper for Pensacola groups. We bid specific stop-loss across three or more carriers because spreads between carriers can move the math meaningfully. We model the PBM economics separately and walk through transparency-PBM alternatives (Capital Rx, Navitus, Rightway) where the spread justifies it. The network rental decision is made last because it follows from the TPA selection.

The deliverable is a written feasibility against the fully-insured renewal: breakeven, upside at 80 percent of projected claims, downside at 110 percent, and the cash-flow profile month by month so the CFO is not surprised by claim-lag patterns. We will tell you when self-funded is not the right move for your Pensacola group. Several long-term clients started with a feasibility, chose level-funded the first year, and moved up the funding ladder over two or three renewals as the data justified it.

Common questions about self-funded plans in Pensacola

Pensacola self-funded questions we get.

At what point should a Pensacola mid-market employer look at self-funded health insurance?
Self-funding typically makes sense at 100 or more lives with stable claim experience and a CFO comfortable with claim-cost variability. Below 100 lives, level-funded captures most of the cost-saving benefit with much less variance. The threshold is less about size and more about claim run-rate stability. If your run-rate has been under 70 percent for three consecutive years you are renting margin to the carrier and self-funding deserves a serious analysis.
What is stop-loss insurance on a self-funded Pensacola plan and how much do we need?
Stop-loss is the reinsurance a self-funded employer buys to cap claim exposure. Specific stop-loss caps the cost of any one claimant in a year (typical attachment $50k to $150k). Aggregate stop-loss caps total claims for the plan year (typical attachment 120 to 125 percent of expected claims). Both are essential for any self-funded employer. Stop-loss carriers and group medical TPAs are often different entities and contract separately.
Do you help Pensacola self-funded plans with Form 5500 filing?
Yes for plans required to file (typically 100 or more participants at the start of the plan year). We coordinate the 5500 with your ERISA attorney or third-party preparer, provide the schedule data, and confirm the filing is submitted via the DOL EFAST2 system by the deadline (last day of the seventh month after plan year end). Most small-group plans qualify for filing exemptions; mid-market self-funded plans usually do not.
Will you actually shop the Pensacola mid-market self-funded landscape or just push one TPA?
We shop. The self-funded market involves multiple moving parts — the third-party administrator (TPA), the specific stop-loss carrier, the aggregate stop-loss carrier, the pharmacy benefit manager (PBM), and the network rental — and each can be sourced from a different vendor. We run RFPs across multiple TPAs (national and regional), at least three specific stop-loss carriers, and transparency-PBM alternatives before recommending a stack.

Ready to get started?

Free renewal analysis, returned in 48 hours, no obligation. For self-funded feasibilities we typically need twenty-four months of paid-claim history; the analysis itself remains free.

Get a free renewal analysis Or call (850) 972-8773

Related Pensacola services: level-funded health plan Pensacola · renewal analysis Pensacola · all services