A fully-insured health plan is the more traditional way to structure an employer-sponsored health plan. With a fully-insured health plan:
- An employer pays a
Payment to your insurance company for health and prescription drug coverage. If you receive health insurance through your employer, your premium may be deducted directly from your paycheck. If you have separate health and dental insurance, you would have two premiums. If you don’t pay your premium, your health care coverage will be cancelled. to the insurance carrier.
- The covered persons (eg: employees and dependents) may share in the cost of the premiums and are responsible to pay any
The amount your health insurance plan requires you to pay for health care services and supplies before they begin to pay. For example, if your deductible is $1,500, you are responsible for paying for all of the services and supplies you receive (except for any covered preventive services) until the amount you paid reaches $1,500. Once the deductible has been reached, your insurance company may pay for all of your health care expenses, or you may have to pay co-insurance, a percentage of the charges. If you have a high deductible health plan, you may be eligible for a Health Savings Account. amounts or co-payments required for covered services under the policy.
- Premiums are based on the number of employees enrolled in the plan each month and rates are fixed for a year but may change if the number of enrolled employees in the plan change.
- The insurance carrier collects the premiums and pays the health care claims based on the coverage benefits outlined in the policy purchased.