In 2019, I worked with a GPS tracking company with twenty employees who had relocated their operations to Tennessee. They were on a fully insured Gold plan running sixteen thousand dollars a month. Renewal was coming, and the numbers were only going to climb from there.
This was not a typical group. The average age was forty five, and all but two of the employees were single. They were spread out across the country, flying out every Monday and coming home every Friday. A workforce built around that kind of travel schedule has its own rhythm and its own risk profile, and it is exactly the kind of group that gets stuck paying for a one size fits all plan that was never designed with them in mind.
Under the Gold plan, the company and its employees were carrying a two thousand five hundred dollar maximum out of pocket. It looked safe on paper. It also cost sixteen thousand dollars a month to run, and a fully insured plan like that one renews based on the carrier's own claims experience and trend assumptions, not on what is actually happening inside the group.
I restructured the coverage onto a level funded plan paired with Medical Balance Protection™. Level funded means the employer pays based on the group's own expected claims rather than a fixed, fully insured premium, with a cap in place so costs do not run away if claims are heavier than expected. The new plan dropped the monthly cost from sixteen thousand dollars to eight thousand dollars, a reduction of half. The tradeoff was real and I do not gloss over it: the maximum out of pocket moved from twenty five hundred dollars to seventy five hundred dollars.
On the surface, a seventy five hundred dollar maximum out of pocket looks like worse coverage than twenty five hundred. It was not, once you add everything up. Medical Balance Protection™ steps in to cover the employee's portion of that maximum out of pocket, paying one hundred percent of hospital, cancer, and pregnancy related costs and fifty percent of lab and imaging costs, so the employee is not left absorbing that covered portion. Between the lower premium and what Medical Balance Protection™ actually covered, employees ended up spending less out of pocket than they did under the old plan, whether they had a heavy claims year or barely touched the plan at all.
That is the part that is easy to miss if you only look at the maximum out of pocket number on a spreadsheet. Whether an employee is healthy or unhealthy in a given year, the plan performs based on what they actually spend, and Medical Balance Protection™ is built around the claims that cause the most financial damage in the first place, not the small, predictable ones.
Of the eight thousand dollars a month in savings, the company kept half to protect its own bottom line. The other half went back to the employees. Their share of the monthly premium dropped by roughly two hundred dollars a month, across the board, every single month, for every employee on the plan.
I am not going to tell you this plan design is right for every company that looks like this one. Every group is different. The right structure depends on the ages in the group, the claims history, the industry, and what the employer is actually trying to solve for. What I can tell you is that for this one, a fully insured Gold plan that cost more every year, on a plan structure that never fit the group it was covering, got replaced with a level funded plan plus Medical Balance Protection™ that cost half as much and protected the moments that matter most.