Abstract: Systems and methods for distributing and mitigating financial risk for health benefit claims of one or more members of a client group among a number of entities are provided. Underwriting data regarding the one or more members of the client group are collected and an actuarial risk analysis of the underwriting data is performed. A first percentage level of an expected aggregate amount of the health benefit claims over the plan period is determined based on the actuarial risk analysis, where the first percentage level defines a first threshold amount below which the client group is financially responsible for the health benefit claims during the plan period. A second percentage level of the expected aggregate amount is also determined, where the second percentage level is being higher than the first percentage level and defines a second threshold amount above which a stop loss insurance carrier is financially responsible for the health benefit claims during the plan period.

Abstract: Systems and methods for distributing and mitigating financial risk among a number of entities are provided. Among several implementations of methods implemented by a computer, one embodiment of a computer-implemented method includes establishing an insurance plan for one or more client groups, each client group comprising one or more members. The method also includes creating at least three layers of financial responsibility within the insurance plan. Each layer of financial responsibility defines an entity responsible for payment of insurance claims within the respective layer. In some implementations, the insurance plan may include an agreement that at least a minimum percentage of the members of each client group participate in one or more wellness programs.