Point C Health blog

Point C Surpasses 100,000 Employee Lives Nationwide

Point C — Thu, 11 Jun 2026 20:53:48 GMT

A Milestone Built on Disciplined Growth

In case you missed it, Point C now supports more than 100,000 employee lives nationwide, marking a major milestone in our continued growth as an independent third-party administrator.

Since our founding in 2019, Point C has increased employee lives covered by 10x and now serves more than 650 employers across 40+ states.

This growth reflects rising demand from employers seeking greater control, transparency, and flexibility in their health benefits as healthcare costs continue to change.

“Surpassing 100,000 employee lives is a proud moment for our team,” said Ben Frisch, Chief Executive Officer of Point C.

“It represents the trust our clients place in us to manage one of their most important investments, employee health plans. This achievement is a reflection of disciplined growth and strong partnerships.”

Independence Matters

As an independent TPA operating without carrier ownership, Point C is able to deliver faster decision-making, deeper client relationships, and the flexibility to innovate while maintaining the operational rigor required to support plans at scale.

Point C helps employers better manage rising healthcare expenses through high-touch customer service, operational expertise, and data transparency, driving value for employers while enhancing the member experience.

Scaling With a Disciplined Focus

“This growth has been intentional,” said Robert Wolfkiel, Chief Growth Officer of Point C.

“Scaling to over 100,000 lives requires strong infrastructure, experienced teams, and close collaboration with brokers and employers. We have built our model to support that growth without losing the personal service our clients expect.”

As a privately held organization, Point C remains focused on:
• Sustainable expansion
• Service consistency
• Product innovation
• Direct access to leadership

Looking Ahead

Crossing the 100,000-life milestone positions Point C for continued national expansion as more employers evaluate alternative funding strategies and seek independent partners with operational strength and accountability.

We will continue investing in:
• Technology
• Talent
• Client and member services

All with one goal: supporting employers with independent, transparent, and operationally strong health plan administration.

Read the full press release here.

Self-Funded Health Insurance 101

Point C — Thu, 11 Jun 2026 20:53:13 GMT

As healthcare costs continue to rise and employers face increasing pressure to offer competitive, sustainable benefits, many organizations are reassessing the structure of their health plans. Among the options gaining significant traction is self-funded health insurance, a model that gives employers more control, more visibility, and, for many, more predictable long-term costs.

Whether you’re an employer exploring your options for the first time or a benefits consultant guiding clients toward more informed solutions, understanding the fundamentals of self-funding is a crucial step toward making informed decisions. Here’s a clear, straightforward breakdown of what self-funding is, how it works, and why more organizations are choosing it.

What Is Self-Funded Health Insurance?

In a traditional, fully insured health plan, an employer pays a fixed premium to a carrier, and the carrier assumes the financial risk for employee healthcare claims.

Self-funding works differently. Under a self-funded plan, the employer pays for its group’s actual healthcare claims directly, rather than paying an insurance company to take on that responsibility. Instead of a fixed monthly premium, employers fund claims as they occur and pay administrative fees for services like claims processing, customer service, and access to provider networks.

To protect against high or unpredictable costs, most employers pair their plan with stop-loss coverage, which provides financial protection above certain thresholds.

How a Self-Funded Plan Works

Although every plan is customized, most follow a similar structure. Employers set aside money to pay for the actual healthcare claims generated by their employees and families. A third-party administrator (TPA), Like us here at Point C, manages day-to-day plan functions like claims adjudication, member support, reporting, compliance, and network access.

Self-funded plans typically include some sort of stop-loss policy, which protects organizations from large individual claims and an unusually large number of claims over the course of a year. Since employers are responsible for paying claims, these policies protect them financially.

Unlike fully insured arrangements, self-funded plans offer robust visibility into cost drivers and utilization patterns, which is a significant advantage for planning and decision-making. Because self-funding is inherently flexible, employers can customize benefits, implement cost-control strategies, and refine the plan design as their workforce evolves.

Why Employers Are Turning to Self-Funding

Self-funding isn’t new, but it is rapidly becoming more attractive to a broader range of employers, including those who previously relied solely on fully insured plans.

1. Greater Financial Control

With a fully insured plan, premiums increase each year regardless of actual claim activity. Self-funded plans, however, allow employers to benefit from lower claims and avoid paying for risks they didn’t use. Over time, this control often leads to more predictable budgeting and, in many cases, meaningful savings.

2. Access to Actionable Data

In a fully insured environment, employers typically receive limited reporting.

Self-funding opens the door to detailed claims data, which empowers employers to identify cost drivers, spot trends early, evaluate program effectiveness, and make decisions based on real utilization. This level of insight helps employers take a more strategic approach to managing their health benefits.

3. Customization for a Changing Workforce

Every workforce is unique, and self-funding recognizes that. Instead of choosing from a predetermined menu of options, employers can design plans that reflect their employees’ needs and organizational goals. That may include:

Targeted wellness programs
Preferred provider networks
Pharmacy strategies
Incentives for preventive care
Benefit options tailored to demographics

The result is a more precise, responsive benefits experience.

4. Strategic Risk Management

Modern stop-loss coverage offers robust protection, giving employers confidence even when facing unpredictable claims. As risk environments evolve, with rising specialty medication costs and emerging therapies, well-structured stop-loss coverage provides a vital layer of financial stability.

5. A Path Toward Long-Term Sustainability

For many organizations, fully insured premiums increase faster than budget growth. Self-funding provides a path toward sustainability by aligning costs with actual utilization and enabling proactive adjustments throughout the year.

It also encourages a long-term strategy centered on prevention, member engagement, and informed decision-making, not simply reacting to annual renewal numbers.

Is Self-Funding Right for Every Employer?

Not necessarily, but as of 2025, 67% of U.S. workers are covered by self-funded health insurance plans. Good candidates for self-funding typically have a stable workforce, predictable claim patterns, a desire for more insight and control, and a willingness to partner closely with a TPA and stop-loss carrier.

With options like level-funded plans emerging, which combine the best of both fully insured and self-funded plans, even smaller groups can explore self-funding with added predictability.

A Stronger Approach to Employee Benefits

Self-funded health insurance offers employers a powerful opportunity to build plans that support both their people and their long-term financial goals. However, the right results don’t come from choosing self-funding alone; they come from choosing the right partner to guide the strategy behind it.

Point C helps employers and brokers navigate every step of the self-funded journey with clarity, confidence, and data-driven insight. From evaluating whether self-funding is the right fit to designing a custom plan and stop-loss structure, our team brings decades of experience to ensure your benefits strategy works for your organization.

Thinking about self-funding or ready to explore what a tailored solution could look like for your team? Connect with Point C to learn more and request a custom quote today.

Self-Funded Health Plan Pitfalls

Point C — Thu, 11 Jun 2026 20:52:36 GMT

Financial Structure Shapes Performance

A self-funded plan’s financial structure plays a major role in how it performs over time. Stop-loss is part of that equation, influencing how risk is managed, how claims are reimbursed, and how predictable costs are from month to month.

When those deductibles, contract terms, or carrier arrangements are not aligned with the plan’s broader strategy, employers may face reimbursement delays, funding gaps, or added financial pressure that can undermine performance.

Data Should Inform Decisions Early

Data is another critical piece of self-funded health plans, but only when it is used early enough to guide decisions.

Looking at multiple years of claims before key decisions are made can reveal specific cost drivers, recurring conditions, and pharmacy trends that will eventually shape plan performance. Without that foundation, projections are built on assumptions, increasing the likelihood of avoidable missteps.

This deeper analysis highlights opportunities for potential changes and targeted interventions, making it a critical step when evaluating self-funding for clients.

Vendor Alignment Drives Execution

Successful plan execution also depends on vendor alignment. Self-funding relies on coordination between a variety of vendors, from third-party administrators (TPAs) to stop-loss carriers to pharmacy partners. When those partners are disconnected, reporting can become inconsistent, accountability can blur, and action can be delayed.

Strong execution depends on:

Clear accountability across partners
Consistent and shared reporting
Defined processes for addressing issues

All of these elements together determine how a self-funded health plan operates.

By bringing together administration and vendor coordination into one platform, Point C is able to reduce fragmentation and improve visibility into plan performance.

Oversight Supports Performance

That visibility must continue after implementation. Self-funding is not a set-it-and-forget-it strategy. Claims activity, vendor performance, and financial results should be reviewed regularly to identify trends and avoid reactive decision-making. Without that level of oversight, cost and utilization problems can build over time and become harder to manage.

A More Disciplined Approach

When these elements come together, employers gain greater visibility and control. When they don’t, issues can surface abruptly and compound over time.

Point C takes a more disciplined approach to self-funding, one that emphasizes alignment, visibility, and ongoing evaluation rather than isolated decisions made at a single point in time. By connecting data, vendor coordination, financial strategy, and day-to-day oversight, that approach helps advisors and employers avoid common missteps early and manage performance more consistently over time.

Evaluating Self-Funding for Clients

Point C — Thu, 11 Jun 2026 20:48:20 GMT

Self-funding is no longer limited to large employers. More midsize organizations are exploring it as healthcare costs continue to rise and flexibility within fully insured plans becomes more limited.

Still, interest alone does not determine fit. Brokers and consultants must evaluate self-funding for their clients to determine whether the self-funding model aligns with the employer’s financial position, workforce profile, and long-term objectives.

Why Employers Are Exploring Self-Funding

Under a self-funded model, employers pay claims as they are incurred and purchase stop-loss coverage for protection against large losses. The approach provides access to detailed claims data and greater plan design flexibility.

According to the Kaiser Family Foundation (KFF) 2025 Employer Health Benefits Survey, 67 percent of covered workers are enrolled in self-funded plans. Adoption is growing, but success depends on preparation and oversight.

Financial and Workforce Readiness

Self-Funding shifts employers from fixed premiums to paying claims as they are incurred. Stop-loss coverage limits catastrophic exposure, but monthly variability becomes part of the model. That shift requires both financial capacity and informed leadership.

Advisors should review two areas together. First, determine whether the organization has the reserve and tolerance to manage claim fluctuations. Second, analyze at least two to three years of claims data to understand recurring high-cost conditions, specialty pharmacy trends, and large claimant frequency.

When you evaluate self-funding for your clients, ask:

Can the organization absorb claims volatility?
Has historical data been fully reviewed before modeling projections?
Does leadership understand how stop-loss impacts total exposure?

Self-funding performs best when risk is evaluated upfront, not after implementation.

Beyond Financials, Execution Determines Performance

Many discussions focus heavily on funding mechanics and less on operational discipline. That imbalance can create problems. Self-funded plans require coordination between the third-party administrator (TPA), stop-loss carrier, and pharmacy partners. Without consistent data review and clear accountability, employers may miss opportunities to adjust plan design or address emerging cost drivers.

The self-funding model alone does not produce results. Ongoing oversight does.

For a deeper look at how administrative partners impact plan performance, see our article on What Holds a Self-Funded Health Plan Together.

A Measured Recommendation

Self-funding can offer greater visibility and plan flexibility when the employer is prepared for the responsibility that comes with it. The model alone does not determine performance. Ongoing evaluation, disciplined funding, and coordinated vendor management make the difference over time.

At Point C, we work with brokers and employers to evaluate self-funding for their clients through detailed claims analysis, stop-loss structuring, and long-term performance oversight. The goal is not simply to transition funding models, but to ensure the strategy aligns with the organization’s financial position and workforce profile.

To learn more about how we support brokers in building and managing self-funded strategies, see our guide to winning business in self-funded.

A health plan strategy should support the broader business. When readiness, the self-funded approach, and oversight align, self-funding can become a sustainable part of that approach.

The Building Blocks of Self-Funded Health Plans

Point C — Thu, 11 Jun 2026 20:47:25 GMT

Self-funded health plans give employers greater flexibility in designing and managing benefits. They also raise a practical question early in the process. Who is responsible for what?

Unlike fully insured coverage, a self-funded plan relies on several partners working together. Each plays a specific role, and understanding those roles helps employers manage their plan more effectively over time.

Plan Sponsorship

The employer serves as the plan sponsor and carries the financial responsibility for claims. This role sets the direction of the plan and shapes how benefits are delivered. While third-party partners and resources handle operational tasks, authority remains with the employer.

Key responsibilities often include:

Funding employee claims
Determining plan design and coverage levels
Selecting and overseeing vendor partners
Medical and pharmacy claims processing
Eligibility and enrollment management
Member services and plan communications
Specific stop-loss, which limits exposure tied to individual members
Aggregate stop-loss, which caps total claims for the plan year
Managing formularies and coverage rules
Contracting with retail and specialty pharmacies
Administering pricing and rebate arrangements
Evaluating vendor performance
Supporting plan design changes
Interpreting data to identify opportunities

Claims and Administration

Claims processing and plan operations are typically handled by a Third-Party Administrator (TPA). The TPA manages the mechanics of the plan and serves as the primary point of contact for members. Although the TPA runs daily operations, it does not ensure the plan or assume financial risk.

Administrative support commonly covers:

Risk Management

Stop-loss coverage helps protect the employer from large or unexpected claims. This protection is usually structured in two ways:

Together, these protections allow employers to self-fund routine claims while managing financial variability.

Provider Access and Pricing

Provider networks play a significant role in both cost control and employee experience. Networks negotiate rates with hospitals and physicians, determine where employees can receive care, and influence how services are used. Employers may choose national, regional, or customized networks depending on workforce location and plan design.

Prescription Drug Oversight

Prescription drugs often represent a growing share of total plan spending. Pharmacy Benefit Managers oversee how medications are priced, accessed, and managed within the plan. Their work typically includes:

Because of the financial impact, this relationship receives increased attention from many employers.

Advisory Support

Advisors and consultants help employers navigate the structure of a self-funded plan. Their role extends beyond placement and often includes:

As a third-party administrator (TPA), Point C supports employers across the full plan lifecycle. Unlike traditional TPAs that focus on claims processing, Point C integrates administration with in-house cost containment, care management, compliance navigation, and consumer-driven solutions. This helps connect strategy to execution rather than addressing issues in isolation.

Bringing the Building Blocks Together

A self-funded plan relies on coordination across multiple partners, each influencing cost, compliance, and employee experience in different ways.

Point C works alongside employers and their advisors to bring structure to that complexity. By aligning plan design, administration, risk protection, pharmacy strategy, and data insights, Point C helps employers move from reactive decision-making to a more deliberate, long-term benefits strategy.

That means fewer disconnected decisions, better use of available data, and a plan that is managed intentionally rather than reactively. By helping employers understand how each component affects the others, Point C supports more informed decisions and steadier plan management over time.

If you’re exploring how to structure or refine your self-funded plan, you can connect with a Point C expert to discuss options and next steps.