Fully-insured vs. self-insured

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 Cost Paid as a fixed monthly premium	Regulatory Oversight State	Regulatory Compliance Shared responsibility between Employer and Medica	Plan Privacy Shared responsibility between Employer and Medica	Claims, Appeals, and Reviews Medica
Self-Insured Medical Plans	Monthly Cost Payment of monthly administrative fee (fixed costs) and claim costs (variable costs)	Regulatory Oversight Federal	Regulatory Compliance Employer responsibility	Plan Privacy Employer responsibility	Claims, Appeals, and Reviews Employer appoints Medica to serve as named claim and appeals fiduciary

Fully Insured Medical Plans

Paid as a fixed monthly premium

State

Shared responsibility between Employer and Medica

Shared responsibility between Employer and Medica

Medica

Self-Insured Medical Plans

Payment of monthly administrative fee (fixed costs) and claim costs (variable costs)

Federal

Employer responsibility

Employer responsibility

Employer appoints Medica to serve as named claim and appeals fiduciary

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