You have an employer health plan if you get your health insurance through your job. If you have an issue with the health insurer, you'll need to know what type of health plan you have so you can get help from the right source. There are three types of employer health plans:
Insured employer health plans
Also referred to as a fully-funded employer health plan, this is when your employer buys a health insurance plan from an insurance company to provide health coverage to its employees. The health insurer directly pays claims for the employees and their dependents. If your employer buys its group health plan, for example, from Regence BlueShield, or Group Health Cooperative, then it may be an insured health plan. Insured health plans are governed by both federal and state laws. If you’re not sure if you have an insured employer health plan, check with your employer.
If you have an insured employer health plan, and need help resolving an insurance problem, file a complaint with us, or call us at 800-562-6900.
Self-funded employer health plans
Large employers, like Boeing, Microsoft or Weyerhaeuser, don’t buy a plan from an insurance company. They provide payments for health care claims from their own funds. If you're employed by a very large employer, then you probably have an employer self-funded plan. In these plans, the employer pays the claims out of a fund or trust. Large employers who self-fund their plans may use third-party administrators (TPA’s) to process insurance claims. Insurance companies often act as administrators.
Self-funded plans are not subject to Washington state insurance laws. Instead, they must follow federal laws, such as the Employee Retirement Income Security Act of 1974 (ERISA) (www.dol.gov). If you have a self-funded plan and need help, contact the:
U.S. Department of Labor - Employee Benefits Security Administration (www.dol.gov)
Seattle District Office
300 Fifth Avenue, Suite 1110
Seattle WA 98104
Self-funded government plans
If you have a self-funded or self-insured health plan through your county, town or religious organization and you have a problem with the plan, you can file a complaint with the plan directly.
Review your employee benefit booklet or contact your employer to find out what kind of plan you have. If you’re still not sure, give us a call at 800-562-6900.