Most commercial health insurers no longer bear much financial risk. Instead they primarily administer health plans on behalf of large self-funded employers. Actual insurance is mostly limited to individual and small group plans, which are a much smaller line of business.

Some numbers here:

https://www.kff.org/report-section/ehbs-2023-section-10-plan...

While everyone calls them "health insurers", the industry term is "managed care organizations" (MCOs), which sell a variety of services, which may or may not include healthcare, managed care, insurance, negotiated pricing, and even retail pharmacy services.