Fully-insured is the traditional model — you pay a fixed premium to a carrier (CareFirst, Kaiser, UHC, etc.) and they bear all claims risk. Self-funded means you (the employer) pay claims directly out of a claims fund and buy stop-loss insurance to cap your exposure on high-claim individuals; used primarily by larger employers. Level-funded is the middle option that’s grown rapidly for small and mid-market employers — you pay a fixed monthly amount (like fully-insured) but the underlying structure is self-funded with stop-loss; if claims come in below the funded amount, you receive a refund at year-end. Level-funded is often the right answer for groups with 25+ healthy lives in our region — same predictability as fully-insured with potential premium savings of 10–25% in good claim years.