Fully-Insured Health Plans
The most traditional structure of the employer-sponsored health plan is the fully-insured health plan model. A fully insured plan encompasses these aspects:
Employer paid premiums are sent monthly to the insurance carrier.
Based on the number of employees enrolled in the plan each month, the premium rates are fixed for a year.
If the number of enrolled employees in the plan changes, so does the monthly premium.
The insurance carrier collects the premiums and pays the health care claims based on the coverage benefits outlined in the respective policy purchased by the employer.
The individuals enrolled and participating in the coverage plan (i.e. eligible members of the workforce and their dependents) are responsible to pay any deductible amounts or co-payments required for covered services outlined under the policy.
