You have an employer health plan if you get your health insurance through your job. There are four types of employer health plans.
Insured employer health plans
These are also called fully-funded employer health plans. This is when your employer buys a health plan from an insurer to provide your coverage. The insurer pays claims for you and your dependents. For example, if your health plan is from Regence BlueShield or Aetna Life Insurance Company, it may be an insured health plan. State and federal laws set requirements for insured health plans. If you’re not sure if you have an insured health plan, ask your employer.
If you need help resolving a problem with an insured health plan, file a complaint with us. You can also call us at 800-562-6900.
Self-funded employer health plans
Large employers, like Boeing, Microsoft or Weyerhaeuser, don’t buy plans from insurers. They use their own money from a fund or trust to pay for health care claims. If you work for a very large employer, you probably have a self-funded plan. Your employer may also use a third-party administrator (TPA) to process claims. Insurance companies often act as administrators.
We don't regulate self-funded plans. Instead, these plans must follow federal laws, such as the Employee Retirement Income Security Act of 1974 (ERISA). If you need help with a self-funded plan, contact the:
U.S. Department of Labor - Employee Benefits Security Administration
Seattle District Office
300 Fifth Avenue, Suite 1110
Seattle WA 98104
866-444-3272
Fax: 206-757-6662
Self-funded government plans
If you work for a non-federal government employer (i.e., city or county government), you may have a self-funded or self-insured health plan. To resolve a problem with this type of plan, you can file a complaint with your plan. We don't regulate self-funded government plans. They're regulated by the Center for Consumer Information and Insurance Oversight:
Center for Consumer Information and Insurance Oversight
888-393-2789
Religious organization health plans
If you work for a religious organization and have a problem with your health plan, read your employee benefits guide or ask your employer how to resolve it. We don't regulate religious organization health plans.