At what size did moving from fully insured to self-funded with stop-loss make sense?

Volatility is real at your size. In four years we have had results of 91%, 88%, 117% and 94% of expected claims. On average we are ahead of fully insured. But the 117% year required a difficult board meeting, and aggregate stop-loss at 120% was what capped it.

What I would have wanted to know: budget to the maximum liability, not the expected figure, for the first two years, and bank the difference as a claims reserve. And ask about lasering at renewal, where the stop-loss carrier sets a higher deductible for a named individual. A no-new-lasers clause with a rate cap is worth paying for.

We looked at 500 employees and stayed fully insured, and I do not regret it. One member with a transplant and one premature birth in the same year would have used our entire reserve. Being self-funded is not automatically the grown-up choice. It depends on how much variance your organisation can absorb without cutting something else.