Some employers are “self-insured.” This means they don’t pay an insurance company for a health insurance plan. Instead, they pay your medical costs directly. This is also called “self-funded.”
Some self-insured employers get help from another company to manage the plan. This company is called a Third Party Administrator (TPA). The TPA tracks medical bills and payments.
Self-insured plans are federally regulated. They don’t have to follow the same rules as plans regulated by the Vermont Department of Financial Regulation. Self-insured plans have to follow a law called the Employee Retirement Income Security Act (ERISA).
If you have questions or problems with your self-insured plan, the human resources department at your job may be able to help. The Employee Benefits Security Administration (EBSA) also helps with these plans. You can call EBSA at 1-866-444-3272.
You can also contact us at the Office of the Health Care Advocate. Fill out our form or call us at 1-800-917-7787 to ask questions.