Heads Up Adviser

2025 Self-Funded Claims Update: What You Need to Know Before Your January 1, 2026, Renewal

Episode Summary

Fourth quarter is here, and with it comes the dreaded renewal season. Employee benefits advisors and employers are seeing shocking increases of 30%, 50%, and even 90%. But why are costs spiraling out of control, and why are so many self-funded plans, captives, and level-funded arrangements failing to deliver on their promise?

Episode Notes

In this episode, John Sbrocco, Founder and CEO of Virtue Health, cuts through the industry jargon to give you a clear-eyed view of the current market. He breaks down the key factors driving medical inflation—from post-COVID utilization and provider consolidation to the staggering rise of catastrophic claims.

Listen to learn: 

• The real story behind renewal increases and the key inflation drivers you need to explain to employers. 
• Why a million-dollar claim is no longer a large claim and how orthopedic and specialty drug costs are impacting your bottom line. 
• The critical flaw in most public pools and captives that leaves well-managed groups subsidizing the risk of others. 
• Actionable cost-containment strategies that focus on the 4% of members driving nearly 50% of the spend. 
• How a private consortium model creates long-term stability and delivers single-digit renewals in a double-digit market. 

LEARN MORE
Heads Up Adviser: https://virtuealliance.com/heads-up-adviser/
Show Sponsor Virtue Health: https://virtuealliance.com/

CONNECT ON LINKEDIN
John W. Sbrocco: https://www.linkedin.com/in/johnwsbrocco/

This is a must-listen playbook for any advisor looking to navigate tough renewal conversations and deliver sustainable results for their clients.