Fully Insured (FI)

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 premium 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 deductible 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. 

 

Trends in benefit richness (average actual value) for NH fully-insured plans (see NH self-insured plans).

NHID 2018 Annual Report - Benefit Buy-down

From year to year, an insurer or employer may reduce the actuarial value of the benefits in a plan to partially offset increasing health care costs.  Buy-down is a measurement of this reduction in benefits and/or increase in cost-sharing requirements. It is a reduction in the total value of benefits.

Using data from calendar year 2017

NHID 2018 Annual Report - Average Deductible


Calendar year 2017 data

 


NHID 2018 Annual Report - Deductibles

NHID 2018 Annual Report - Coinsurance Comparison

Calendar Year 2017 data

NHID 2018 Annual Report - Primary Care Office Visit Copay

D/C means that the member cost sharing is subject to the deductible and/or coinsurance

PCP Office Visit Copay Distribution for CY 2017

NHID 2018 Annual Report - Maximum Out-of-Pocket

Single Policy Out-of-Pocket Distribution for CY 2017

NHID 2018 Annual Report - Rx Copays