--- title: "Case Study: Risk Segmentation - RMC Group" description: How a Midwestern firm used creative risk segmentation to provide health insurance coverage for an employee with chronic illness. image: https://rmcgp.com/hubfs/blog132.jpg --- [ ← Back to Blog ](https://rmcgp.com/blog) # Case Study: Risk Segmentation Written By RMC Group Published on: January 13, 2020 **Categories:** Health and Benefits ![Case Study: Risk Segmentation](https://rmcgp.com/hubfs/blog132.jpg) #### **How a Midwestern firm used creative risk segmentation to provide health insurance coverage for an employee with chronic illness** ##### **The Problem** A Midwestern company with 100 employees across seven locations discovered that an employee in their Northeast office was disqualified from coverage under their new self-funded health plan. As a result, the company had to consider returning to a more costly fully-insured health plan for all employees. The company did not discover this problem until it was able to analyze health data from their self-insured plan, which wasn’t available under their prior fully-insured carrier. ###### **What is risk segmentation?** One way for companies to deal with higher risks is to segment groups into risk tiers and charge different premiums for each tier. ##### **The Solution** ###### **How did the company implement risk segmentation?** By adopting a risk segmentation strategy, the Midwestern company was able to segment its Northeast office onto a fully-insured plan that covered the high-risk employee. Meanwhile, employees at the other six locations remained on the company’s self-insured health plan. By removing the 16 employees in their Northeast office, the company had enough employees to meet the legal requirements to maintain a self-funded health plan. As an added bonus, risk segmentation helped the company achieve significant savings.  By creatively structuring its self-funded health plan and segmenting out the Northeast location, the company realized greater underwriting profit. This savings went straight to the company’s bottom line. ###### **Is risk segmentation right for your business?** To assess a self-insured health plan or risk segmentation is right for you, [contact](https://rmcgp.com/contact-us) an RMC professional today. ## Related Blog Posts [![Closing the Gap: What Women's Retirement Security Day Means for Your Future](https://rmcgp.com/hubfs/RMC%20-%20Blog%20Header-Jul-08-2026-07-55-51-4334-PM.png) ](https://rmcgp.com/blog/closing-the-gap-what-womens-retirement-security-day-means-for-your-future) ### [Closing the Gap: What Women's Retirement Security Day Means for Your Future](https://rmcgp.com/blog/closing-the-gap-what-womens-retirement-security-day-means-for-your-future) On Women’s Retirement Security Day, we spotlight the retirement savings gap between women and men—and what you can do about it. Building a secure retirement isn't easy for anyone. But for women, the... 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