{"id":62,"date":"2026-05-27T14:24:13","date_gmt":"2026-05-27T18:24:13","guid":{"rendered":"http:\/\/offplan.network\/?page_id=62"},"modified":"2026-08-28T12:51:28","modified_gmt":"2026-08-28T16:51:28","slug":"fully-insured","status":"publish","type":"page","link":"http:\/\/offplancare.com\/es\/business\/employers\/fully-insured\/","title":{"rendered":"Totalmente asegurado"},"content":{"rendered":"
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Fully Insured Employers<\/p>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

You are paying the most for healthcare and getting the least from it.<\/h1>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/section>\n\n\n
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Fully insured is the most expensive way to deliver care that your employees are afraid to use.<\/h2>\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t
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Every year, your carrier sends a renewal with a higher number. You negotiate. Maybe you shop carriers. Maybe you raise deductibles. The result is the same: your employees pay more, use care less, and the next renewal is worse. You have no visibility into where the money goes because the carrier does not show you. You are buying a product designed to profit from your inability to see what it costs.<\/p>\n<\/div>\n\t\t\t\t<\/div>\t\t\t\t\t<\/div>\n\t<\/div>\n\n\t\n<\/div>\n<\/section>\n\n

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Already on a high-deductible plan?<\/strong> The HDHP path is a focused walkthrough for fully insured employers with HDHPs, including the 2026 HSA + DPC rules, employee experience, and funding mechanics. See the HDHP path \u2192<\/a><\/p>\n\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\n\t\n<\/div>\n<\/section>\n\n

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The Real Cost<\/p>\n\t\t\t\n\t\t\t\t\t\t\t

What fully insured is actually costing you.<\/h2>\n\t\t\t\n\t\t\t\t\t\t\t

It is not just the premium. It is everything the premium hides.<\/p>\n\t\t\t\t\t<\/div>\n\t\n\t\n\t\t\t

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1. 7 to 10% annual increases.<\/span><\/h3>\n\t\t\t\t\t\t

Not anomalies. That is the model working exactly as designed. You are in a community-rated pool with every other employer. Your good claims experience subsidizes someone else’s bad year. The carrier’s pricing model is built to compound, not to reward you.<\/p>\n\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t

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2. Employees afraid to use the benefit.<\/span><\/h3>\n\t\t\t\t\t\t

High deductibles mean your employees avoid care until something becomes an emergency. The $2,000 to $5,000 deductible you added to keep premiums manageable is now a barrier between your employees and a doctor. That is not healthcare. That is a coupon with a catch.<\/strong><\/p>\n\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t

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3. No visibility.<\/span><\/h3>\n\t\t\t\t\t\t

You do not see claims data. You do not know which conditions are driving cost. You cannot manage what you cannot see. Your carrier can. They just do not share it with you.<\/p>\n\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t

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4. PBM margins built into the premium.<\/span><\/h3>\n\t\t\t\t\t\t

Your carrier’s pharmacy benefit manager earns on spread pricing and retains rebates. Those costs are baked into your premium but never itemized. You are paying for someone else’s margin on every prescription.<\/p>\n\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t

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5. Or worse: you cannot offer insurance at all.<\/span><\/h3>\n\t\t\t\t\t\t

For many SMBs with 5 to 25 employees, fully insured premiums are simply unaffordable. You lose candidates to larger companies because you cannot offer a health benefit. Your employees go uninsured or buy individual plans. You absorb the productivity cost of a workforce that avoids the doctor.<\/strong><\/p>\n\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\n\t\t\t

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Either way, you are paying for access to a system your employees avoid.<\/em><\/p>\n\t\t<\/div>\n\t\n<\/div>\n<\/section>\n\n

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The Structure Change<\/p>\n\t\t\n\t\t\t\t\t

OffPlan replaces the structure, not the protection.<\/h2>\n\t\t\n\t\t\t\t\t

The 80\/20 problem is worst in fully insured plans because you are paying carrier margin, carrier admin, and carrier profit on every doctor visit, every lab, every prescription. OffPlan removes all of that for the 80% of care that never needed insurance. Real protection stays for the 20% that does.<\/p>\n\t\t\t<\/div>\n\t\n\t\t\t

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T1<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t

Primary Care + Specialist Care (80% of spend)<\/h3>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t

A dedicated physician for every employee. Same-day access. 45-minute visits. Chronic disease management. Specialist referrals through a curated cash-pay network. Transparent pharmacy. No co-pays. No deductibles. No claims. No carrier involvement. Fixed monthly cost that does not increase at 7% a year.<\/p>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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Intermediate Event Protection<\/h3>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t

Protection for unexpected events below the major-event threshold. ER visits, urgent care, injuries, minor procedures. Hospital indemnity and accident insurance. HSA-compatible.<\/p>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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T3<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t

Protecci\u00f3n para eventos mayores<\/h3>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t

Stop-loss protection for hospitalizations, major surgery, and serious medical events. This is what insurance was designed for: rare, expensive, unpredictable events. This is the only layer that involves insurance. This is the only layer exposed to annual renewal.<\/p>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\n\t\n\t\n<\/div>\n<\/section>\n\n

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The Platform<\/p>

This is not just a doctor. It is a platform.<\/h2>

You could contract with a DPC practice for $75 to $125 a month and get your employees unlimited visits. But that does not change your renewal. It does not coordinate specialist care. It does not give you data. It does not manage your population’s health. OffPlan does all of that.<\/p>\t\t\t<\/div>\n\t\t<\/div>\n\t\n\t\t\t

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Population health analytics<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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For the first time, you see what is happening across your employee population. Utilization patterns. Chronic disease prevalence. ER diversion. Claims avoidance. Data you have never had because your carrier never shared it.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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Predictive risk stratification<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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Which employees are trending toward high-cost events. The platform surfaces it. The physician acts before it becomes a claim.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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Specialty care coordination<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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Pre-vetted, pre-priced cash-pay providers. No PPO markup. No facility fees. No surprise bills. eConsults to avoid unnecessary referrals. The employee shows up and pays $0.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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A dedicated account manager<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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Quarterly business reviews with your HR team. Enrollment management. Advisor coordination. A real person who owns your relationship.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t

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The data to prove it at renewal<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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After 12 months, you have clinical and utilization evidence your advisor can use to negotiate level-funded or self-funded terms. That data is worth more than the membership itself<\/strong> because it is what breaks you out of the fully insured cycle permanently.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\n\t\t\t

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The physician delivers the care. The platform delivers the results.<\/p>\n\t\t<\/div>\n\t\n<\/div>\n<\/section>\n\n

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The Employee Experience<\/p>

What changes for your employees.<\/h2>

This is not a downgrade. It is the opposite.<\/p>

Your employees get better care than they have ever had.<\/strong> And you pay less than you are paying now.<\/p>\t\t\t<\/div>\n\t\t\t

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\n\t\t\t\t\t\t\t\tToday (Fully Insured)\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/th>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\tWith OffPlan\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/th>\n\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t<\/thead>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t$2,000 to $6,000+ deductible before insurance pays\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t$0 deductible for primary care.<\/strong> No co-pay. No claim.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t3-week wait. 12-minute visit. See a stranger.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tSame-day access. 45-minute visits. A doctor who knows their name.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tAvoid the doctor because it costs too much\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tUse the doctor because it costs nothing\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tER for after-hours care. $3,000 to $8,000 bill.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t24\/7 access to care. Urgent needs handled day or night.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tMRI: $1,200 to $3,000 after deductible\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tMRI: ~$350<\/strong>. Employer-funded benefit card. $0 to the employee.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tSurprise bills. Balance billing. Confusion.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTransparent pricing. No surprises. No bills in the mail.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t\t\t\t\t\t\t<\/tbody>\n\t\t\t<\/table>\n\t\t<\/div>\n\n\t\t\n\t\t\t\t\t
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Today (Fully Insured)<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t$2,000 to $6,000+ deductible before insurance pays\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

With OffPlan<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t$0 deductible for primary care.<\/strong> No co-pay. No claim.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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Today (Fully Insured)<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t3-week wait. 12-minute visit. See a stranger.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

With OffPlan<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tSame-day access. 45-minute visits. A doctor who knows their name.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t

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Today (Fully Insured)<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tAvoid the doctor because it costs too much\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

With OffPlan<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tUse the doctor because it costs nothing\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

Today (Fully Insured)<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tER for after-hours care. $3,000 to $8,000 bill.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

With OffPlan<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t24\/7 access to care. Urgent needs handled day or night.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

Today (Fully Insured)<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tMRI: $1,200 to $3,000 after deductible\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

With OffPlan<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tMRI: ~$350<\/strong>. Employer-funded benefit card. $0 to the employee.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

Today (Fully Insured)<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tSurprise bills. Balance billing. Confusion.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t

With OffPlan<\/p>\n\t\t\t\t\t\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTransparent pricing. No surprises. No bills in the mail.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\t

\n\t\t\t\t\t
\n\t\t\t\t\t\t