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The prior article of this series said the city was “self-insured” for healthcare, and “the city insures itself with money from its budget rather than going through an insurance company”. So if there is no insurance company, it’s not clear how to reconcile that with this article, which says: “As of the most recent budget, FY2020, the cost for supplying union employees with medical and dental insurance has jumped . . ” Is this supposed to be insurance or self-insurance ? How does self-insurance jump? More and longer hospital visits? With self-insurance, you only pay for what you actually use. An insurance company mitigates the odds of any possible claim by raising rates, which you pay for, whether you use it or not.