Fully Insured is another way of saying there is no-risk or liability as the policyholder and the insurance company assumes all the risk aside from paid premiums. This is the most common form of group insurance. This form of insurance best fits groups who have less than 100 employees, but there are of exceptions.

Typically as the policyholder you won't get any specific data regarding trends of utilization or specific claims information. Truly, this is the most hands off approach to group insurance. For groups/organizations that do exceed 100 benefit eligible employees, you will start to receive loss and trend information as your rates are now instead of being community rated are rated on the merit of the group and are underwritten by the carrier.

Here are a list of common characteristics of fully-insured health plans

  • Rates are fixed up to one year
  • Monthly premiums only change with the number of enrolled members
  • Health plans for groups considered "small group" are community rated and typically age-banded
  • No risk is passed to the group/organization

Below is an illustration of how fully-insured premiums typically itemize or breakdown.

Fully-Insured