Traditional & Fully Insured Plans

How it works

You pay a rate. The carrier carries the risk.

Every month you pay a premium per enrolled employee. The carrier pays the claims, whatever they come to. If the year goes badly, that is the carrier's problem. If it goes well, the surplus is the carrier's too.

What it is good for

Complete budget certainty for twelve months
No claims administration to think about
State-regulated, with guaranteed issue in the small group market
Simple to explain to a board

What it costs you

A good claims year produces no refund
Claims detail is limited, so you cannot see what drives the renewal
State premium tax and carrier margin are built into the rate
In many states, small groups are community rated — a healthy group subsidises the pool

What we do with it

Fully insured does not mean unshoppable.

A renewal that arrives at fourteen percent is an opening position. Roughly half the increases we are handed move once the plan is actually marketed.

1

Ask for the data

Even fully insured groups are entitled to more than most brokers request. Large-claimant summaries and pharmacy reports change what a carrier will do.

2

Adjust plan design before funding

Deductible, coinsurance and out-of-pocket max moved deliberately, with the employee cost impact shown by tier rather than in aggregate.

3

Pair with an HSA where it fits

A qualified high-deductible plan with an employer HSA contribution frequently costs less in total than the richer plan it replaces, and the employee ends the year ahead.

4

Quote the alternative anyway

We price a level-funded option alongside every fully insured renewal. Sometimes it is the right answer, sometimes it is only leverage. Either is useful.

When fully insured is genuinely the right answer

It is the right answer more often than the self-funding literature suggests. Groups with heavy known claims, groups too small for credible stop-loss underwriting, and groups with no appetite for month-to-month variability are all better off with a fixed rate. So is an employer with nobody available to look at a monthly claims report.

The mistake is not choosing fully insured. It is choosing it by default, year after year, without ever seeing what the alternative would have cost.

Have your renewal reviewed Compare with self-funding

Request a review

Send the renewal, and we will tell you what we would change

No fee, and no obligation to move the business. Most employers who contact us are simply trying to work out whether the number in front of them is a fair one.

(800) 779-4090
info@waughagency.insure
22 Bateson Drive, Andover, MA 01810

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