Fully Insured Health Plans
Greater certainty. Covered claims backed by an insurer.
With a fully insured group medical plan, the employer pays premiums and the insurance company assumes responsibility for covered medical claims under the policy.
Specific products and availability are subject to confirmation.
Why employers consider it
An established option for businesses that want to transfer covered medical-claims risk and budget around agreed premium rates during the policy term.
- The employer chooses among the plans available from carriers in its market.
- Actual benefits, provider networks and employee costs depend on the policy that is issued.
- Premium rates are set for the policy term and reviewed at renewal.
When we discuss this category we are referring to major-medical group coverage. Not every policy an insurer issues is comprehensive medical coverage, and a policy does not meet minimum value simply because a licensed insurer issued it. That has to be confirmed for the specific plan.
Important consideration
Premiums may change at renewal, and total payments can change with enrollment. The policy determines covered services and exclusions.
What to confirm before deciding
- Which carrier plans are actually available to your group.
- The provider network and how your employees use care.
- Employee deductibles, copays and out-of-pocket maximums.
- Renewal terms and how rates are reviewed.
Considering a different level of risk?
Level-funded and self-funded arrangements shift some or all of the claims funding to the employer, in exchange for more visibility and potential benefit when claims are lower.