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Insurance Guide | Question 5

Is the patient covered under an Employer-Provided Plan?

Employers have two options when providing their employees with group insurance – a Self-Funded plan or a Fully-Insured plan. Each plan is regulated differently.

Self-Funded Plans (Self-Insured) – A plan offered by employers who directly assume the major cost of health insurance for their employees. Some self-insured employers contract with insurance carriers or third-party administrators for claims processing and other administrative services (e.g. Carefirst, Cigna) while other self-insured plans are self-administered (e.g. JHU EHP, county government). Self-funded plans are regulated by the Federal Government and are not subject to state mandates. Employers may offer both self-insured and fully-insured plans to their employees.

Fully-Insured Plans – A plan where the employer contracts with another organization (such as CareFirst, Cigna, United, etc.) to assume financial responsibility for the enrollees’ medical claims and for all incurred administrative costs. Fully-insured plans are subject to all mandates in the state in which they are purchased.

If you are not sure which type of policy you have, review your Summary Plan Description and/or contact your employer benefits office, insurance carrier, or the Maryland Insurance Administration at 410-468-2000 or 800-492-6116.

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