Fully-Insured Health Plans: Group Coverage - provide employees with quality benefits while keeping costs low for employers

Fully-insured health plans are purchased from an insurance company or underwriter that assumes full risk for medical expenses that may occur. The premium amounts set by the insurance company are generally set at a rate that will allow them to cover all projected expenses and ensure there will be adequate profit margins remaining.

For smaller companies - generally those with 0-50 employees - premiums are generally community rated based on a carrier’s filing for a specific community. Mid-size employers with 50-100 employees will be demographically-rated; for larger companies, premiums are projected based on the loss history involved.

The advantages of fully-insured health plans are that all financial risks are assumed by the insurance company and there is no complex administration of plan required. The insurance carrier is undertaking the risk of paying for potential claims and will be in charge of administering the claims process. For smaller employers, it may not be prudent to assume the risk of a self-insured program or the cost associated with administering such a program. With a fully-insured program, there is a more pre-determined risk with no administration costs - but the insurance carrier will be the one to profit from any premium remaining after claim costs and expenses.

Broad Coverage Service specializes in analyzing the challenges of each company and determining whether the application of a fully-insured health plan is prudent - and will work with clients to choose the appropriate carriers and plans in an effort to provide employees with quality benefits while keeping costs low for employers.