Unlike other types of group policies, with self-insured health insurance, the employer is the one who bears the financial risk of paying the employee’s medical bills. The employer basically becomes the insurance company.
There are many differences in how self-insured health plans are implemented and employees insured in this way must be very active in learning how to properly administer the plan. While the plans are regulated nationally by the Employee Retirement Income Insurance Act (ERISA), the exact details may vary from company to company. You can learn more about how ERISA functions by browsing online.
Fortunately, ERISA requires a Summary Plan Description (SPD) from every company that offers this type of insurance. The SPD is a document that sets out all the policies and procedures you can follow to get your health benefits.
You can also make sure you know who your plan administrator is. This will be the person managing the day-to-day health plan. While some services are usually outsourced to third parties, the administrator should be someone you can contact if you have questions, concerns, or concerns.
The most important thing about self-insured health insurance is that it is not regulated or controlled by a government insurance agency. If you have a serious medical claim that is denied, you must use the complaints procedure established by your employer.
Billing practices may also vary from company to company. Some employers may require you to prepay your entire medical bill and send a reimbursement receipt later. Others can only pay part of the fee.
If you are covered by an independent health insurance plan, read your SPD proposal, find out who your plan administrator is, and ask questions if necessary. Remember that with your health insurance policy, you are largely responsible for how you work.