Employers establishment of a health plan must consider both the type of health plan to offer, and how the health plan will be structured. There are two common ways to structure a group health insurance plan: fully insured and self-insured (or self-funded) 
So what is the difference between a fully insured health self-assured. plan?
fully insured against self-assured (self-funded) health plans
A fully insured health plan is the most traditional way to structure a sponsored health plan by the employer. With a fully insured health plan:
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The company pays a premium to the insurance company
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Premium rates are fixed for one year. , Based on the number of employees enrolled in the plan each month.
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The monthly premium only changes during the year, if the number of employees enrolled in regime change.
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The insurance company collects premiums and pays for health care applications based on the coverage of benefits set out in the policy purchased.
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The persons covered (eg employees and dependents). Are responsible for paying deductibles or co-payments required for services covered under the policy
With health plan (self-financed) self-insured, employers (usually larger) operate their own health plan rather than buying a fully insured from an insurance plan. Employers choose to self-insure, as it saves them the profit margin that an insurance company adds to its premium for a fully insured plan. However, self-insurance exposes the company to much greater risk if more claims than expected to be paid. With a self-funded health plan:
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There are two main costs to consider :. Fixed and variable costs
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The fixed costs include administrative costs, stop-loss premiums and other fixed charges per employee. These costs are billed monthly by TPA or carrier, and are charged based on the enrollment plan.
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The variable costs include payment of health care claims. These costs vary from month to month depending on the use of health care by persons covered. (For example: the employees and dependents)
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To limit the risks, some employers use stop-loss or excess of loss insurance reimburses the employer for claims that exceed a predetermined level. This cover can be purchased to cover catastrophic losses on a covered person (specific hedging) or to cover claims which significantly exceed the expected level for the group of people covered (coverage of aggregates).
Variations of self-assured (self-funded) health plans
In addition to the types of self-insured health plans described above, there are changes in health self insured plan that help employers reduce the cost of health insurance:
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a partially self-insured health plan with an integrated HRA a variant of a part of oneself. Non-Insured Health Plan is to increase the deductible on the group health insurance plan and self-insure the difference with a health arrangement integrated reimbursement (HRA). For example, the company is increasing the deductible from $ 500 to $ 5,000. The company uses a HRA to reimburse employees for up to $ 4,500 (the difference in the franchise). Using the HRA this way, the employer is self-insured for additional deductible of $ 4500 and to see cost savings, because most employees will not reach their $ 5,000 deductible.
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A Self- insured medical reimbursement plan: Another variant is a repayment plan for self-insured medical expenses, as a repayment plan care health (HRP). Many employers (usually smaller and medium) set up a HRP to reimburse employees for health insurance premiums - instead of offering a group health plan. HRP is not health insurance, but a section 105 self-insurance plan that provides reimbursement for eligible Medicare premiums. HRP is often used as the basis of a health plan defined contribution "pure"
What questions do you have to fully insured against self-insurance plans or self-funded health? What other changes do you see? Leave a comment below.
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