1.) Payments
The company pays a premium, typically fixed for a year, to the insurance carrier. The monthly premium normally only changes during the year if the number of enrolled employees in the plan changes
2.) Assumption of Risk
The insurance carrier collects the premiums and pays the health care claims based on the coverage benefits outlined in the policy purchased.
3.) Benefit Design
The covered persons (that is, employees and dependents) are responsible to pay any deductible amounts or co-payments required for covered services under the policy. These plans are usually limited by the insurers plan designs
4.) Regulation
The Plans must comply with federal AND state regulations
