What are the differences between fully insured plans and self-insured plans?
If you’re new to self-insurance, there are several differences from a fully insured plan, including:
Fully Insured Medical Plans |
Monthly CostPaid as a fixed monthly premium |
Regulatory OversightState |
Regulatory ComplianceShared responsibility between Employer and Medica |
Plan PrivacyShared responsibility between Employer and Medica |
Claims, Appeals, and ReviewsMedica |
Self-Insured Medical Plans |
Monthly CostPayment of monthly administrative fee (fixed costs) and claim costs (variable costs) |
Regulatory OversightFederal |
Regulatory ComplianceEmployer responsibility |
Plan PrivacyEmployer responsibility |
Claims, Appeals, and ReviewsEmployer appoints Medica to serve as named claim and appeals fiduciary |
Employer Service Center
For groups headquartered in Minnesota, North Dakota, South Dakota and Wisconsin:
1-800-936-6880
For groups headquartered in Iowa and Nebraska:
1-866-894-8052
Monday – Friday: 8 a.m. to 5 p.m.
Closed 8 a.m. to 9 a.m. Thursdays