Annual double-digit increases in health insurance premiums may be the reality for school districts and private-sector employers for the foreseeable future. The author presents several factors that account for this unwelcome possibility. One cost-saving alternative for districts is to self-insure employees and assume the risks. Districts are turning to self-insurance as a way to cut costs while meeting the needs of their employees. Under such a program, the district collects premiums from its employees and pays for each out-of-pocket claim from its own operating budget instead of paying a fixed premium to an insurance carrier. Self-insurance can be a way to save money by avoiding the administrative overhead and company profit that are factored into the price of a private-sector plan.