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3 votes
Who is financially liable for the payment of covered claims in a fully insured group health plan?

- A) Employer
- B) Insurer
- C) Employee
- D) Healthcare provider

asked
User Parnell
by
8.6k points

1 Answer

0 votes

In a fully insured group health plan, the insurer is financially responsible for paying the covered claims. Employers are mandated to offer health insurance but do not pay these claims directly. Option B is correct.

Step-by-step explanation:

In a fully insured group health plan, the party financially liable for the payment of covered claims is the insurer. These plans are typically offered by an employer or union to employees and can also cover their families. The insurer is the one who bears the risk of providing healthcare benefits under the terms of the insurance contract.

As such, when a covered healthcare service is provided, the insurer is responsible for paying the claim according to the policy's coverage provisions. Employers have a mandate to offer health insurance if they have more than 50 employees, but they are not the ones paying the covered claims.

answered
User Amitdigga
by
8.0k points
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