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📋 '''Self-insured plan''' is a benefit program — most commonly for [[Definition:Health insurance | health coverage]] — in which the sponsoring employer or organization directly finances [[Definition:Claim | claims]] incurred by plan participants rather than paying [[Definition:Premium | premiums]] to an [[Definition:Insurance carrier | insurance carrier]] under a fully insured arrangement. The term is functionally synonymous with a [[Definition:Self-funded plan | self-funded plan]] and is used interchangeably across much of the insurance and benefits industry, though "self-insured plan" appears more frequently in regulatory and legal contexts.

🔄 Plan sponsors typically hire a [[Definition:Third-party administrator (TPA) | third-party administrator (TPA)]] or use an insurer's [[Definition:Administrative services only (ASO) | administrative services only (ASO)]] platform to manage enrollment, adjudicate claims, negotiate [[Definition:Provider network | provider network]] contracts, and handle compliance filings. Because the employer bears the [[Definition:Underwriting risk | underwriting risk]], most self-insured plans incorporate [[Definition:Stop-loss insurance | stop-loss insurance]] to cap exposure — [[Definition:Specific stop-loss | specific stop-loss]] protects against any single high-cost claimant, while [[Definition:Aggregate stop-loss | aggregate stop-loss]] triggers when total plan claims exceed a predetermined threshold. The employer retains claim-level [[Definition:Claims data | data]] ownership, an advantage that enables more sophisticated [[Definition:Data analytics | analytics]] and population health strategies.

🎯 For the insurance industry, self-insured plans represent both a competitive challenge and a revenue opportunity. On one hand, every employer that moves to self-insurance is a traditional [[Definition:Group insurance | group insurance]] policy that doesn't renew. On the other, carriers earn substantial fees through ASO contracts and stop-loss [[Definition:Underwriting | underwriting]] — a line of business that has become one of the fastest-growing segments in employee benefits. [[Definition:Insurtech | Insurtech]] startups have entered this space with platforms that help smaller employers self-insure for the first time by bundling stop-loss, TPA services, and cost-containment tools into a single offering, further blurring the boundary between fully insured and self-insured models.

'''Related concepts:'''
{{Div col|colwidth=20em}}
* [[Definition:Self-funded plan]]
* [[Definition:Stop-loss insurance]]
* [[Definition:Administrative services only (ASO)]]
* [[Definition:Third-party administrator (TPA)]]
* [[Definition:Group insurance]]
* [[Definition:Aggregate stop-loss]]
{{Div col end}}

Definition:Self-insured plan - Revision history

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