Health Insurance · Studio Build

Health insurance
is broken.
We want to fix it.

Employers will spend over $18,000 per employee on health insurance in 2026, with premiums climbing 5–10% every year. Forum AI Studio is looking to build with a founder in this space and we're writing the first check.

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$1.7T

US employer healthcare spend in 2025. Larger than the GDP of Mexico.

$26,993

Average family premium in 2025. Same price as a new Toyota Corolla.

$18K+

What the average employer will spend per employee in 2026.

What we believe

A category getting more expensive every year, with no one fixing it.

The health insurance brokerage market is a $400B+ revenue line built on a structure that hasn't changed in 40 years. Brokers earn 4-8% of premium for placing a plan and managing a renewal. When premiums go up, they earn more. Efficiency cuts their own commission. The people closest to the problem are paid to leave it alone - exactly the kind of market where AI-native builders win.

Group captives, AI-powered TPA tooling, and CMS price transparency rules are pulling self-funded structures down into the 25-200 employee cohort for the first time - roughly 6 million US businesses with no incumbent built to serve them. We're exploring two distinct entry points into this market, and we're looking for the founder with the conviction to own one of them.

Two Paths In

The entry point shapes the whole company.

Both approaches are fundable. Both are aimed at the same broken market. What we're looking for is a founder with enough conviction in one path - and enough background to back it up - to cut through long sales cycles in a space where trust is the only real moat.

Path A

AI-native broker

Sell fully-insured plans like any broker. AI does the heavy lifting on quoting, plan comparison, employee Q&A, and renewal modeling. Commission revenue funds the build. Migrate qualifying clients to self-insured structures over time.

Fastest path to revenue, commissions from day one
Lower regulatory surface at inception
Distribution and trust built before the migration
Margin upside when clients move self-funded
Path B

Fully bundled plan sponsor

Design, underwrite, and deliver the plan directly with no carrier middleman. Concierge-layer differentiation becomes the product, not an add-on. Premium experience commands premium pricing.

Full stack distribution, admin, and risk
Pricing model decoupled from premium size
Differentiation on experience, not just cost
Higher regulatory lift, higher moat if cleared

Why Now

Three shifts converging at the same time.

01

Risk is now manageable

Group captives let employers as small as 25 employees pool stop-loss reinsurance. WTW reports 40%+ of employers are using or considering captives. Million-dollar-plus claims jumped 30% in 2024 - adoption accelerated rather than slowed.

02

Administration is getting cheap

The TPA model has been opaque and expensive for 40 years. AI collapses the unit economics on claims processing, eligibility, prior auth, and compliance - the exact operational layer that made self-insurance feel impossible for a 75-person company.

03

The cost is now undeniable

Health insurance has stopped being a benefit line - it's one of the biggest costs on every P&L. The system has run out of answers. Employers are ready to hear a different pitch.

"Health insurance is becoming a hot topic because it just goes up every year. Premiums go 5 to 10% every year, no end in sight. Every health investor I'm talking to knows the space needs innovation. It's where we want to build next."

Michael Cardamone - Managing Partner, Forum Ventures

What the winning company looks like

Services-heavy on day one with improving margins over time.

Whether the wedge is brokerage or plan sponsorship, the endgame is the same - a vertically integrated, AI-native benefits company that owns distribution, administration, navigation, and risk financing in one stack. The customer doesn't buy a SaaS tool. They buy the outcome.

STEP 01

Day one - sell

Revenue starts immediately, whether from broker commissions or per-member plan fees. AI handles quoting, plan comparison, employee Q&A, and renewal modeling.

STEP 02

Year two - migrate or deepen

Broker path: move qualifying clients onto self-insured structures with captive access. Per-employee revenue grows 3-5x. Plan sponsor path: layer in adjacent products as data accumulates.

STEP 03

Endgame - own the stack

The operating system for SMB health benefits - distribution, administration, navigation, and risk financing. The data moat compounds with every renewal.

Companies we've backed

We've been building in health for a while.

Our portfolio includes companies across benefits navigation, care delivery, and AI-powered health infrastructure. We understand the regulatory surface, the payer dynamics, and what it takes to build trust with healthcare buyers.

Outfox Health

Benefits Nav

AI answer engine turning price transparency data into actionable care decisions - real contracted rates, quality scores, and lower-cost options inside any existing plan.

outfoxhealth.com →

Luro Health

Care Delivery

AI-augmented virtual obesity care embedded into community health centers - a fully managed multidisciplinary team integrated into existing EHR workflows at no cost to the center.

lurohealth.com →

Finni Health

Specialty Care

ABA therapy platform matching families of children with autism to vetted providers across 30+ states. Accepts most major insurers and handles intake, scheduling, and progress tracking end to end.

finnihealth.com →

Blooming Health

Care Management

AI-powered omnichannel platform automating screening, outreach, referrals, and follow-up for 1,500+ health organizations across 25 states and 22M+ member engagements.

gobloominghealth.com →

The next company we back will work upstream of all of these - owning the employer relationship, the plan design, and the data that makes better care possible.

Forum's Track Record

12

Years of experience

550+

Companies funded

$1.25B+

Follow-on funding

Building in health insurance?
Let's talk.

We write the first check and build alongside you from day zero.

First conversation to term sheet runs about four weeks when it's a fit.

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