FULLY INSURED HEALTH PLANS
A Set-It-and-Forget-It Approach
A fully insured health plan may be offered through major carriers such as Blue Cross Blue Shield, UnitedHealthcare, Cigna, and Aetna, providing predictable costs and comprehensive coverage.
Fully Insured Health Plans: Predictable Costs, Comprehensive Coverage
Unlike traditional brokers, Memberly brings a unique advantage—we operate in both the fully insured and self-funded markets. This means we can provide an unbiased comparison, helping employers determine whether a fully insured plan is the best fit or if a self-funded solution could offer greater cost savings and flexibility.
Memberly is appointed with all major carriers, including Blue Cross Blue Shield, UnitedHealthcare, Cigna, and Aetna, ensuring access to a wide range of fully insured health plan options.
Fully Insured vs. Self-Funded Health Plans
Financial Risk
In a fully insured plan, the employer transfers all financial risk to the insurance carrier by paying a fixed monthly premium, ensuring predictable costs regardless of claims. In contrast, a self-funded plan exposes the employer to potential financial volatility, but risk can be mitigated using stop-loss insurance, which limits the employer’s liability for high-cost claims.
Fully Insured
Self-Funded Plan
Carrier
Carrier assumes risk
Employer
Employer assumes risk
Claims Management
In a fully insured plan, the insurance carrier handles all claims processing and payments, simplifying administration for the employer but limiting cost control. In a self-funded plan, the employer is responsible for paying claims as they arise, typically partnering with a third-party administrator (TPA) to process claims and manage provider networks.
Fully Insured
Self-Funded Plan
Carrier
Handled by the insurance carrier
TPA
Managed by TPA
Cost Structure
A fully insured plan has a fixed-cost where employers pay a set monthly premium to the insurance carrier, ensuring predictable expenses but often at a higher long-term cost. In contrast, a self-funded plan operates on a variable-cost model, which can lead to cost savings but also fluctuations. Level funding smooths out these variations by allowing employers to pay a consistent monthly amount.
Fully Insured
Self-Funded Plan
Fixed
Fixed monthly premium.
Variable
Variable cost based on claims
Plan Customization
A fully insured health plan offers limited customization, as employers must choose from predefined options set by the insurance carrier, restricting flexibility in benefit design. In contrast, a self-funded health plan allows employers to tailor coverage, provider networks, and wellness programs to better align with employee needs and cost-saving strategies.
Fully Insured
Self-Funded Plan
Limited
Limited to carrier plan
options
Flexible
Greater flexibility in benefits design
Regulatory Oversight
Fully insured health plans are regulated at the state level, meaning they must comply with state insurance laws, mandated benefits, and premium tax requirements. In contrast, self-funded health plans are governed by federal regulations under ERISA (Employee Retirement Income Security Act), which provides more flexibility in plan design but also requires strict compliance with reporting and fiduciary responsibilities.
Fully Insured
Self-Funded Plan
State Laws
Subject to state insurance regulations
ERISA
Governed by federal ERISA regulations
Potential Savings
Fully insured health plans often have higher long-term costs because employers pay fixed premiums that include carrier profit margins, administrative fees, and state taxes. In contrast, self-funded plans allow employers to pay only for actual claims incurred, potentially leading to significant savings over time, especially in years with lower healthcare utilization.
Fully Insured
Self-Funded Plan
Higher Cost
Less financial risk, but higher long-term costs
Lower Cost
Potential cost savings, but more financial exposure
Minimum Participation
Most fully insured health plans require a minimum percentage of eligible employees to enroll in coverage to maintain the plan’s pricing and stability. This minimum participation requirement varies by carrier but typically ranges from 50% to 75% of eligible employees. Employers must meet this threshold to qualify for coverage and avoid potential rate increases or plan denial.
Valid Waivers
Employees who decline coverage due to having valid waivers—such as enrollment in spousal coverage, Medicare, Medicaid, or another group health plan—are typically excluded from the participation calculation. By ensuring enough employees enroll while accounting for valid waivers, employers can maintain compliance with carrier guidelines and secure the best possible rates for their health plan.
Memberly helps businesses navigate these requirements to ensure a smooth and compliant enrollment process.
Fully Insured Quoting Process
The quoting process for a fully insured health plan involves gathering a employee census and comparing multiple carriers and plan designs to find the best fit. Memberly streamlines this process by collecting essential data, analyzing coverage options, and negotiating competitive rates on your behalf.
Already in a Fully Insured Plan? Now’s the Time to Compare!
If you’re already in a fully insured plan, we’ll compare your options and ensure you’re getting the best value. Memberly conducts a thorough market analysis, evaluating multiple carriers and plan designs to uncover potential savings and stronger coverage. To get started, simply provide your most recent health plan invoice, a summary of benefits (SBC), an employee census including date of birth, zip code, and coverage tier, and the renewal date of your current plan.
Recent Carrier Invoice
Renewal Notice
Employee Census with dependents
Current Plan SBCs
Affordable Dental & Vision Plans to Complement Your Health Coverage
Memberly helps employers enhance their benefits package by pricing dental and vision plans from top carriers to complement a fully insured health plan. We compare multiple providers to find the most competitive rates and coverage options, ensuring a seamless fit with your existing healthcare benefits. With our expertise, you can offer employees comprehensive, high-quality dental and vision care while maintaining cost efficiency.
Dental Coverage
Vision Coverage
Enhance Your Fully Insured Plan with Life, Disability & Critical Illness Coverage
Memberly helps employers enhance their benefits package by pairing fully insured health plans with group term life, disability, and critical illness insurance for comprehensive employee protection. We compare top carriers to find the best coverage options, ensuring financial security for employees in the event of unexpected health challenges or loss of income. By bundling these benefits, businesses can offer well-rounded coverage while optimizing costs and improving employee retention.
Life
Disability
Critical Illness
Common Questions
Learn More About Fully Insured Health Plans
Blue Cross Blue Shield
BCBS is a federation of 33 independent and locally operated health insurance companies across the United States, collectively providing coverage to over 115 million people. (en.wikipedia.org)
Each BCBS company operates independently within its designated service area, offering health insurance plans tailored to the needs of their local communities. These companies are licensed by the Blue Cross Blue Shield Association (BCBSA), which oversees the use of the BCBS brand and ensures compliance with its standards.
BCBSA is the national federation that licenses the BCBS brand to independent health insurance companies. It provides strategic leadership, sets quality standards, and facilitates collaboration among the member companies.
BCBSA grants licenses to independent health insurance companies, allowing them to use the BCBS brand within specific geographic territories. These licensees, such as Anthem and Horizon, operate under the BCBS name in their respective regions, adhering to BCBSA guidelines and standards.
Anthem is an independent licensee of BCBSA, operating BCBS-branded plans in multiple states, including California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin.
Horizon Blue Cross Blue Shield of New Jersey is the only licensed BCBS plan in New Jersey, providing health insurance coverage to over 3.2 million people throughout the state.
BCBS licensees benefit from brand recognition, access to a nationwide network of providers through programs like BlueCard, and shared resources for best practices and innovations in healthcare delivery.
The BlueCard Program allows BCBS members to receive healthcare services while traveling or living in another BCBS plan's service area. It simplifies claims processing and ensures members have access to in-network benefits across the country.
Yes, self-funded employers can lease access to the BCBS network through third-party administrator (TPA) agreements. By doing so, they can offer their employees the benefits of BCBS's extensive network of doctors, hospitals, and healthcare providers, while retaining control over their plan design and funding. This allows businesses to benefit from negotiated rates and nationwide provider access without fully insuring the plan.
Cigna
Cigna offers a variety of fully insured health plans, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), and Open Access Plus (OAP) plans. These plans provide different levels of flexibility in choosing healthcare providers and managing out-of-pocket costs.
Cigna's network includes a vast number of healthcare professionals and facilities across the United States. Specific numbers can vary by region and plan type. To find in-network providers, you can use Cigna's online provider directory.
You can use Cigna's online provider directory to search for in-network doctors, specialists, and healthcare facilities. This tool allows you to filter by location, specialty, and other criteria to find a provider that meets your needs.
Yes, self-funded employer health plans can access Cigna's extensive provider network through Administrative Services Only (ASO) agreements. This arrangement allows self-funded employers to benefit from Cigna's negotiated provider rates and nationwide network.
Cigna offers administrative services, claims processing, provider network access, and data analytics to self-funded employers. These services help businesses manage healthcare costs while maintaining quality care for employees.
As of 2025, Cigna provides health coverage to over 17 million medical customers globally, including employer-sponsored, Medicare, Medicaid, and individual insurance plans.
UnitedHealthcare
UnitedHealthcare provides HMOs, PPOs, EPOs, and POS plans, each offering different levels of provider flexibility and cost-sharing options.
UnitedHealthcare's network includes more than 1.5 million physicians and healthcare professionals, and over 6,200 hospitals across all 50 states.
UnitedHealthcare is a division of UnitedHealth Group, a multinational healthcare and insurance company.
You can use UnitedHealthcare’s online provider directory to search for in-network doctors, specialists, and healthcare facilities.
Yes, self-funded employer health plans can access UnitedHealthcare’s vast provider network through third-party administrator (TPA) agreements. This allows companies that self-fund their employee health benefits to take advantage of UnitedHealthcare's negotiated rates and broad provider access.
UnitedHealthcare offers administrative services, claims processing, provider network access, and data analytics to self-funded employers. These services help businesses manage healthcare costs while maintaining quality care for employees.
UnitedHealthcare provides health coverage to over 50 million individuals across employer-sponsored, Medicare, Medicaid, and individual insurance plans.
Aetna
Aetna provides HMOs, PPOs, EPOs, and POS plans, each offering different levels of provider flexibility and cost-sharing options.
Aetna’s network includes approximately 1.86 million healthcare professionals, over 800,000 physicians, and more than 6,300 hospitals across the U.S.
Aetna is a subsidiary of CVS Health, which acquired the company in 2018.
You can use Aetna’s online provider directory to search for in-network doctors, specialists, and healthcare facilities.
Yes, self-funded employer health plans can access Aetna’s provider network through Administrative Services Only (ASO) agreements. This allows self-funded employers to benefit from Aetna’s negotiated provider rates and nationwide network.
Aetna provides claims processing, provider network access, data analytics, and cost management tools for self-funded employers. These services help businesses control healthcare expenses while offering high-quality care to employees.
Aetna provides health coverage to approximately 39 million individuals across employer-sponsored, Medicare, Medicaid, and individual insurance plans.
Aetna partners with over 800,000 employers, offering fully insured and self-funded health plans to businesses of all sizes.
