Self-insured coverage means that the employer or association pays for enrollees' medical care directly. Fully insured coverage means that health insurance is being purchased from an insurance company (either by an employer or by an individual) and the insurance company will be the entity responsible for paying for medical care. Self-insured health plans can be administered by the employer or association, but it's common for a third-party administrator (TPA) to be used. The TPA is often a commercial insurance carrier, so the employees' ID cards might have the name of an insurance carrier on them, and the plan might use that insurer's provider network. But a TPA is only administering the plan; the employer is still taking on all of the financial risk and covering the cost of employees' claims.