Self-funded or self-insured health care plans pay benefits from a fund established by an employer or organization. Self-funded plans are not insurance plans and therefore do not come under the authority of the Michigan Office of Financial and Insurance Regulation. Self-funded health care plans are created under federal law and come under the authority of the federal government.

Self-funded health care plans are administered by third party administrators or insurance companies. The Michigan Office of Financial and Insurance Regulation has authority over third party administrators and licenses such entities, therefore, we may be able to assist you with some problems by contacting the third party administrator.

A third party administrator is a person or organization who processes claims and may perform other administrative services in accordance with a service contract.

If the problem is not with the third party administrator, you may have appeal rights under the Federal Employee Retirement Income Security Act (ERISA) and you may wish to contact the U.S. Department of Labor, Employee Benefits Administrator (EBSA), 1885 Dixie Highway, Suite 210, Fort Wright, KY 41011. You may also contact them toll-free at (866) 444-EBSA or at www.dol.gov/ebsa/.

The easiest way to find out if your health care is self-funded or insured is to ask your employer. You may also find the answer in the benefit information provided by your employer. Often if the word "plan" is included as part of the name of the coverage, it is a self-funded health care plan. Most large employers provide health care benefits through self-funded health care plans.