Anonymous R2I client case · Northeast Ohio · 156 employees
A manufacturer wanted more than another fully insured renewal. Ready-2-Insure helped the firm move to a level-funded health plan. One set payment covered claims funding, plan support, and stop-loss insurance. R2I reports $218,000 in first-year savings compared with the projected renewal.
Executive summary
| The business | The decision | The reported result |
|---|---|---|
| Light manufacturing and distribution company in Northeast Ohio | Move from fully insured coverage to a level-funded arrangement | $218,000 in year-one savings versus projected renewal |
| 156 employees, with a mixed-age workforce | Review medical funding, pharmacy costs, and claims reporting together | 23% reduction in prescription costs |
| Leadership needed a more predictable payment structure | Fund expected claims through a set monthly payment | $142 per employee per month in reported employer payments |
The key change: The firm could see what it paid for and how members used the plan. The review brought plan funding, drug costs, and claims data into one decision.
Why the Ohio group health insurance renewal needed a different approach
In the prior fully insured plan, good claims years did not produce a direct refund for the firm. In worse years, renewal increases exceeded 20%. The firm had not been shown other ways to fund its plan.
The firm wanted a set monthly payment, better claims data, and a chance to receive unused funds under the plan’s terms.
R2I’s employee benefits consulting for Ohio employers starts with those goals. Headcount was one part of this review. The team also looked at the workforce, quoted terms, costs the firm could face, and the work needed to run the plan.
How the level-funded plan was structured
One monthly payment, three components
The new plan combined fees to run the plan, stop-loss premiums, and money set aside for expected claims. An independent third-party administrator, or TPA, handled claims and other plan services. A TPA is an outside company hired to do that work.
R2I reports a $142 per employee per month, or PEPM, employer payment. It covers plan fees, network access, reports, stop-loss premiums, and claims funding. That is the firm’s payment, not a stated total that includes employee payments. It is a result for this client, not a quote for another business. The firm’s 156 employees should not be treated as 156 enrolled employees.
Protection for large individual and total claims
The case used $50,000 specific stop-loss. That policy can pay eligible claims above the threshold for one covered person. It also used aggregate stop-loss set at 120% of expected eligible claims. That protection applies to the plan’s total eligible claims above its threshold.
The contract sets the rules for which claims count, when they must be paid, and what happens if the plan ends. A fixed monthly payment does not remove every duty or cost the firm may face.
A separate pharmacy review
The drug plan was separated from the medical plan and placed with a pharmacy benefit manager, or PBM. A PBM manages drug benefits. The new approach gave the firm a clearer view of that part of its plan.
The review looked at drug costs on their own. The firm also gained a claims dashboard and added a wellness program with health screenings. Reports about the group as a whole helped the team see cost patterns. This public case does not name members or describe their health.
The reported savings and plan insights
- $218,000 in first-year savings compared with the projected fully insured renewal.
- $67,000 returned from unused claims reserves, tracked separately from the savings figure.
- 23% lower prescription costs under the revised pharmacy arrangement.
- 8% of members accounted for 64% of claims costs, an aggregate finding that helped focus the plan review.
The refund reflects this case’s contract and claims results. It is not promised to other groups. The $218,000 savings and $67,000 return are separate figures; do not add them into one savings claim.
What this means for Ohio employers considering level-funded plans
Level funding can offer set monthly payments and a stake in the plan’s results. Look beyond the monthly number. Compare expected costs, the most the firm may owe under the contract, network access, drug terms, and reports. Check what happens to unused claims funds.
For a January 1 renewal, ask those questions before choosing how to fund the plan. R2I’s renewal review is a starting point. The stop-loss guide explains the coverage and contract questions in more detail.
Level-funded health insurance questions
Is level funding the same as fully insured coverage?
No. In a level-funded plan, the firm funds claims and pays for plan support and stop-loss. In a fully insured plan, the insurer takes on covered claims in return for premiums. Compare costs, duties, and reports before changing funding.
Does every level-funded plan return unused claims money?
No. The contract states if funds can be returned, how the amount is worked out, and which rules apply. This case’s $67,000 return is a client result. Do not assume every plan has the same terms.
What does PEPM mean in this case?
PEPM means per employee per month. Here, $142 is the firm’s payment for plan fees, stop-loss, and claims funding. To work out an annual cost, first confirm who is enrolled and how the payment is counted. Total headcount alone is not enough.
Can an Ohio manufacturer compare options before changing brokers?
Yes. Start with current plan summaries, who pays what, the renewal offer if you have it, and the team’s goals. R2I can help define which options need a closer look and which facts are needed next.
Give your renewal a complete comparison
Bring your renewal date, rough employee count, and the issue you most want to solve. R2I will help define the next steps to review cost, coverage, and funding.
Source and basis: R2I supplied and confirmed these client facts and results. Savings compare with a projected renewal, not prior-year spend. The time periods, enrollment, and terms belong to this case. Results vary by group.