In a fully insured group health plan, who is financially responsible for paying covered claims?

In a fully insured group health plan, the insurer takes on the financial responsibility for paying covered claims. In these arrangements, the employer pays a premium to the insurance company, and in return, the insurer guarantees to cover certain healthcare costs incurred by the members of the group. This arrangement allows employers to offer health benefits without having to directly manage the claims and payouts, as that responsibility falls to the insurer.

Members do pay part of their healthcare costs, such as copayments or deductibles, but the bulk of the claims related to covered services is managed and paid by the insurance company. This structure provides a clear delineation of financial responsibility, where the risk is transferred from the employer and insured members to the insurer.

Government programs do not factor into this scenario unless we are discussing a specific plan that involves government health benefits, which is not the case in a standard fully insured group plan.