This I’m not as clear on and it for sure differs between companies. But most if not all small businesses are not self-insured. They use a larger insurance compa

This I’m not as clear on and it for sure differs between companies. But most if not all small businesses are not self-insured. They use a larger insurance company like BCBS who pays out, and the company and employees split the cost of the premiums. Obviously if an employee has high costs that may figure into next year’s premiums but insurance companies are built for this type of thing and it’s not as crazy as you might think. For larger companies (such as T-Mobile, google, or any other 5k+ employee company it starts to make sense to self insure and only have the insurance company administrate the plan, tho for Amazon scale it looks like they’ve started self administrating as well. Point is once you reach that scale everything looks different and you can absorb an expensive employee.