Smarter Employee Benefits for Small and Mid-Sized Businesses

Health insurance and employee benefits are essential tools for attracting and retaining top talent. But for many small and mid-sized businesses, rising costs and complex rules make it hard to keep up without sacrificing quality or compliance.

That’s where we step in.

At Horvath & Partners, we help employers design benefit packages that make financial sense, for your company and your employees. Whether you are fully insured or self-funded, we will guide you through the options that reduce cost, lower your average group age, and provide better coverage to those who need it most.

We specialize in:

• Aligning Medicare-eligible employees and spouses with better-fit coverage

• Moving younger dependents to Marketplace plans when appropriate

• Evaluating plan options for cost savings and simplicity

• Ensuring compliance with ACA, ERISA, and Medicare Creditable Coverage rules

This is not about switching carriers every year—it is about having a long-term strategy that protects your team and your bottom line.

What’s the Difference? Fully Insured vs. Self-Insured vs. Level-Funded Plans

Choosing the right group health plan structure affects cost, flexibility, and compliance responsibilities. Here’s a simple breakdown of the three most common funding models.

Fully Insured Plans

The insurance carrier takes on all the risk. You pay a fixed monthly premium, and they handle the claims.

• Easy to administer

• Stable monthly premiums

• No risk if employees have high claims

• No ACA 1094/1095-C filing required

• Typically the most expensive option over time

Ideal for businesses that want simplicity and predictability without extra paperwork.

Self-Insured Plans

You take on the risk by paying for your employees’ medical claims directly. Most businesses also purchase stop-loss insurance to limit exposure to large claims.

• Greater control over plan design and costs

• Lower long-term costs if claims are low

• Access to detailed claims reporting

• Requires strong cash flow and claims management

• You are responsible for ACA employer reporting

  (Forms 1094-C and 1095-C must be filed each year)

Ideal for mid-size to larger employers seeking maximum cost control and transparency.

Level-Funded Plans

A hybrid model that offers the cost savings of self-funding with the predictability of a fully insured plan. You pay a fixed monthly fee that includes claims funding, stop-loss protection, and admin costs.

• Fixed monthly payments (easier budgeting)

• Potential refund if claims are low

• More affordable than fully insured plans

• Provides some claims data for smarter decisions

• Still requires ACA reporting (1094-C/1095-C forms)

Ideal for small to mid-size businesses that want savings without the financial volatility of full self-funding.

ACA Compliance Reminder

• Fully Insured Plans: The insurance carrier handles all ACA reporting. No extra work for you.

• Self-Insured & Level-Funded Plans: The employer is legally responsible for ACA reporting, including filing Forms 1094-C and 1095-C with the IRS every year. This can be handled in-house or through a benefits partner.

Not sure which model fits your business?

We’ll walk you through the numbers, the risks, and your reporting responsibilities, so you can make the best decision for your people and your budget.