The carrier owns the risk. The employer pays one fixed premium. This page covers how a fully insured arrangement is filed and rated under the State Corporation Commission Bureau of Insurance, how it fits alongside Virginia's Insurance Marketplace, and which Virginia employer profiles default to it.
The financial flow, the carrier's role, and the Virginia filings that govern every fully insured group plan.
What the structure does. The employer pays a fixed PEPM (per employee per month) premium to a licensed carrier. The carrier holds the full underwriting risk, processes every claim out of its own reserves, and owns the loss ratio. The employer never sees an itemised claims report and never funds claims directly. Premium is set at issue and renews on a 12-month cycle, with rate change driven by trend, demographic factors, and (for groups above the small-group threshold) the group's own experience.
How it lands in Virginia. In Virginia, fully insured plans are filed and reviewed by the State Corporation Commission Bureau of Insurance. Small groups buy through carriers active on Virginia's Insurance Marketplace and the broader state small-group market, with risk-adjustment running through Virginia's ACA market. Employers concentrated in Northern Virginia, Richmond, and Hampton Roads use fully insured arrangements as their default first arrangement, particularly in the federal government / defense contracting (Northern Virginia, Pentagon corridor), healthcare systems, and shipbuilding & maritime (Hampton Roads) sectors.
The regulatory boundary. Fully insured plans are state-regulated under each state's insurance code and subject to ACA market rules including community rating for small groups. In Virginia, the State Corporation Commission Bureau of Insurance reviews every form and rate filing for fully insured group product.
The fully insured arrangement is the most common starting point. Here is who tends to stay there in Virginia, and who tends to outgrow it.
Typical buyer profile. Most often selected by employers in the 2 to 50 employee range, or by mid-sized groups that prioritise budget predictability over claims-data transparency. A common landing point for first-time benefits buyers, professional-services firms, and employers whose owners want zero monthly variability in the benefits line.
Virginia employer clusters. In Virginia, fully insured plans show up most heavily in smaller employers across federal government / defense contracting (Northern Virginia, Pentagon corridor), healthcare systems, and shipbuilding & maritime (Hampton Roads), where the budget predictability of a fixed monthly carrier premium matters more than claims-level visibility. The largest concentrations are in Northern Virginia, Richmond, and Hampton Roads.
How Virginia policy context interacts. Virginia expanded Medicaid in 2019 under §32.1-325.04, enacted by a bipartisan General Assembly majority — the only Southern state outside the traditional expansion belt to expand through direct legislative action (rather than a ballot referendum), and the last major Medicaid expansion before the COVID pandemic. For fully insured buyers, this affects which employees move between the employer plan and Cardinal Care, which in turn shapes the underwriting profile that carriers and TPAs price against.
Typical tradeoffs. Premium predictability and zero claims-administration overhead, traded against no surplus participation, no claims-level visibility, and limited plan-design control.
Carrier premium, small-group rules, and how fully insured plans interact with Virginia's Insurance Marketplace.
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