Choosing a self-insured health plan model has always offered employers some advantages, including better transparency and more control over their healthcare spending than is possible with a fully insured model. This year’s worldwide COVID-19 pandemic has further highlighted the reasons why employers should consider a self-insured strategy over a fully insured model.
Key differences
In a fully insured model, the insurance carrier covers risk. The carrier determines the employer’s premium rates based on age, demographics, and underwriting factors. Often, the insurer must pool risk among several employers to create a larger population. When risk is blended with the populations of several other employers, premiums do not reflect the specific risks of any one population. If your employer group has a particularly healthy year, you pay the same premiums as less healthy groups in your risk pool. The insurance company largely recoups the rest as profit.
