Decoding Medical Plan Structures: Fully Insured vs. Self-Funded

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Learn the history of medical plans and how the American health insurance system developed into it's current state. This section will help HR and Finance professionals actually understand the mechanisms behind traditional fully insured plans and their self funded plan counterparts. It will also introduce some key concepts around Stop Loss, Third Party Administration, and Medical Plan Underwriting

Basic Course Information

Learning Objectives

• Trace the evolution of the American health insurance system and explain how historical developments have shaped the structure and financing of modern medical benefit plans.
• Differentiate between fully insured and self-funded medical plans by describing their financial mechanics, risk structures, underwriting processes, and key components—including stop loss coverage and third-party administration.
• Identify and interpret core regulatory and underwriting concepts impacting employer-sponsored medical plans, including the role of medical underwriting, compliance requirements, and risk management strategies within the current regulatory environment.

Major Subjects

Medical Plan Types