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Many mid-market employers have not reviewed their health plan funding
A Kaiser Family Foundation survey found 27% of workers at firms with 10 to 199 employees are in self-funded plans, while average annual family premiums rose to $26,993 in 2025, up 6.0% year over year.
Insurance Business reports that most mid-market employers tend to revisit health benefits only at renewal time, focusing on the new rate rather than whether their health plan funding structure still fits. The article argues that many companies never evaluate whether the way they fund coverage, and the level of claims visibility they receive, remains appropriate.
The outlet points to Kaiser Family Foundation data from the 2025 Employer Health Benefits Survey. It found that 80% of covered workers at large companies are enrolled in self-funded health plans, versus 27% at firms with 10 to 199 employees.
Insurance Business says the higher costs of staying put are increasing pressure to revisit funding models. It cites the KFF figure for the average annual family premium at $26,993 in 2025, a 6.0% year-over-year increase, and notes that covered workers at smaller firms contributed an average of $8,889 toward family coverage compared with $6,227 at larger firms.
The article also outlines why funding structure decisions matter for cost control and budgeting. It explains that fully insured plans offer fixed premiums and cost certainty, while employers under those arrangements can have limited access to their own claims data, and it describes level-funded plans and group captives as middle-ground options, including that 37% of covered workers at firms with 10 to 199 employees are now in level-funded plans, according to KFF.