• Anthem Blue Cross »
• Aetna »
• Health Net »
• Kaiser »

• California Supplemental Medigap Insurance »
• Anthem Blue Cross »
• Blue Shield of California »

California Health Insurance - Affordable Health Insurance Quotes in California

Self-Insured Health Plans (Single Employer Self-Insured Plans)

Self-Insured Health Plans have gained in popularity among large employers, labor unions, school districts and other municipalities. These groups provide a pool of money and then proceed to pay for the health care services of their members (employees) from this pool. It is common for self-insured plans to turn over the administration of their health plans to a Third Party Administrator (TPA). The TPA handles all administrative tasks including claims processing and payments. Often the employer will contract with an insurance company to act as a TPA for all health care claims.

Most self-insured health plans fall under the Employee Retirement Income Security Act (ERISA). ERISA is federal law that is enforced by the U.S. Department of Labor, Employee Benefits Security Administration (DOL-EBSA). If you are a member of a self-insured health plan through your employer or union, then you can contact the DOL-EBSA for assistance. However, the DOL-EBSA does not regulate self-insured health plans that are sponsored through school districts, other municipalities, and churches. If you are a member of this type of plan, you can file a complaint with the plan directly or you may seek a legal remedy through a court of law. The DOL-EBSA is available to answer questions about self-insured employer plans that come under ERISA regulation. You can gain information on the type of plan that you participate in by contacting your employer or union. If there is still some question, then you can contact the DOL-EBSA for clarification. Please see the "Resources" section of this brochure.

Important Points to Remember About Self-Insured Health Plans:

• If you work for a large employer, have a union affiliation, work for a school district, or work for a municipality, the health plan offered to you may be a self-insured entity.
• An insurance company or a TPA may administrate a self-insured health plan.
• Self-Insured health plans are most likely subject to federal ERISA law.
• If your self-insured health plan is not a school district, other municipality, or a church, you can seek help from the DOL-EBSA.
• If your self-insured health plan is a school district, other municipality, or a church, you may seek assistance from the plan directly or from the courts.

Multiple Employer Welfare Arrangements (MEWAs)

MEWAs permit employer members of trade, industry, professional, and other associations to create trust funds for the purpose of offering and providing health care benefits to their employees. Because of significant and widely publicized mishandling of claims by MEWAs in the 1980s and early 1990s, legislation was passed to more closely regulate MEWAs. This legislation forced all MEWAs to file applications for certificates of compliance by November 30, 1995, or cease operating in California. Only MEWAs that satisfied strict requirements were granted certificates of compliance. It is now illegal for new MEWAs to form and to offer health care benefits. Currently, fewer than ten MEWAs have been issued certificates of compliance by the CDI, which permit them to operate legally in California. If your employer presents a health plan to you involving a new MEWA, then contact the CDI immediately. If you receive your health care benefits through one of the approved MEWAs, then you may seek assistance from the CDI if you have any questions or complaints. Please see the last page of this brochure for complete CDI contact information.

Important Points to Remember About Multiple Employer Welfare Arrangements:

• Your employer may offer a MEWA health plan if they are an employer member of a trade, industry, professional, or other association.
• There are currently less than ten MEWAs operating with CDI certificates of compliance.
• After November 30, 1995, no new MEWAs can form, operate, or apply for CDI certificates of compliance.
• You can contact the CDI for any questions regarding MEWAs.