Regulation of Self-Funded Health Insurance Plans
Part 2, Chapter 6: Self-funded Plans Page 3
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Table 13: Comparison of Self-funded Plans and Traditional Health Insurance Plans
| Traditional Plan | Self-funded Plan |
| Established by an insurance company | Established by a plan sponsor such as a corporation, a union, an association, or a state or municipal government agency |
| Regulated by state agencies, including the state Department of Insurance, the state Department of Health, or by special state health insurance boards | Regulated through ERISA (the federal Employee Retirement Income Security Act), implemented by the Pension and Welfare Benefits Administration of the U.S. Department of Labor |
| Claims paid by the insurance company | Claims paid by the plan sponsor (the sponsor may also have a reinsurance program) |
| Appeals may be filed with the insurer, the state Department of Insurance, the state Department of Health, or with other organizations | Appeals may be filed with the plan administrator, the plan sponsor, or the Pension and Welfare Benefits Administration of the United States Department of Labor |
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