Is a fully insured health plan the right option for you?
Previously available only to self-funded groups, Surest expanded its reach to the fully insured market in 2020. Since then, more and more employers have been opting for the fully insured offering, available in select states (and growing on a regular basis).
What does fully insured mean?
The main difference between an employer-sponsored self-funded health plan and an employer-sponsored fully insured health plan lies within who assumes the financial risk. With a fully insured plan, the risk associated with paying employees' medical claims falls on the insurance carrier. With a self-insured health plan, that risk falls to the employer.
How does a fully insured health plan work?
When people think about traditional health insurance, they often think of a fully insured arrangement.
- The employer pays a fixed per-member premium to the insurance carrier for covered health care services. These fixed costs typically include administrative expenses, stop-loss and employee fees.
- In exchange, the insurance carrier pays for health care claims accrued during the plan year.
What are the main advantages of fully insured?
- Employers are protected from costly medical claims: This scenario is largely why employees pay premiums to an insurance carrier—so they’re not underwriting their own risk. The monthly cash flow, when it comes to health care expenses, is predictable and consistent.
- Simplicity of management: Employers without the time or resources to dedicate to managing one more thing may consider fully insured health plans a convenient option.
How is plan pricing determined with a fully insured health plan offering?
Plan pricing is based on the number of enrolled employees, employee health and health care usage. Depending on how the plan performs, pricing can change year over year. In the meantime, costs are rolled up into the monthly insurance premium paid by employees.
In comparison to fully insured, what are the risks of a self-funded plan?
Employers opting for self-funded plans are taking a risk by not knowing how many claims they’ll be incurring during the plan year. The employer might like the idea of potentially saving money, but it doesn’t take much for medical expenses to add up (and quickly). If an employer doesn’t have the financial resources to absorb the costs of an employee needing an organ transplant, for instance, or getting into a serious accident, those multi-million-dollar medical claims could be catastrophic, especially to a smaller company. To mitigate this, some self-funded employers will purchase stop loss insurance. Stop loss insurance shifts liability back to the insurance company when claims exceed a predetermined amount. The tradeoff? Stop loss policies cost money, too.
What is the Surest health plan?
The Surest plan can be an employer’s “secret weapon” in saving money and increasing employee satisfaction. There’s no deductible and no confusing coinsurance to calculate, so the health care benefit starts working for employees right when it’s needed. The plan is designed to be easy to use. Through the Surest experience, members can see coverage options and clear costs on the Surest app/website and compare prices and treatments. Even better, prices are low for what we consider higher-value options, such as those based on quality, efficiency and overall effectiveness of care.
What benefits are covered by the Surest fully insured offering?
The Surest plan covers basic health care needs—expected and unexpected—including:
- Prescription drugs
- Preventive care (your annual checkup, some health screenings, vaccinations)
- Primary and specialty care
- Hospital services
- Urgent and emergency services
- Most diagnostic testing (ultrasounds and bloodwork)
- Mental and behavioral health services
- Maternity care
- Cancer care
- Treatment for chronic conditions
- Substance use disorders
- And more
What network does the Surest plan utilize?
The Surest plan utilizes the broad, national UnitedHealthcare provider network.
So... which one is better? Fully insured or self-funded?
There are advantages to both fully insured and self-funded plan options. The “better” plan depends on a company’s financial resources. There is room in the market for both plans to peacefully coexist.
Ready to learn more about the Surest fully insured health plan option? Contact us.
Surest redesigned health insurance to give employers the opportunity to offer a sustainable, attractive health benefit—without compromising coverage or quality. Members can see treatment options and compare costs before making a decision. The Surest health plan delivers the freedom to choose—and the information to choose wisely.