The Playbook for Transitioning to Self-Funded Health Plans in New England

For decades, most New England employers relied heavily on traditional fully insured health plans. Annual renewal cycles were more predictable, risk was fully transferred to carriers, and administrative overhead remained manageably low.

Today, many New England employers face a different reality due to fundamental shifts. Less favorable medical loss ratios, increased specialty pharmacy pricing, and overall healthcare inflation have substantially impacted this traditional model. As employers navigate major premium increases that operate independently of their actual workforce claims experience, many benefits leaders across New England are evaluating alternative healthcare financing models.