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Your rights and benefits depend on how you are insured. If you get insurance through your employer, the laws governing your plan differ depending on whether your employer is large (51+ employees) or small (2-50 employees). Rules are different for individual policies and government plans. If you don’t know your plan type and get insurance through your employer, ask your benefits representative, usually the Human Resources or Personnel departments. You can also call the number on your insurance card.

What Does Self Insured Mean? To further complicate things, if you are insured by a large employer, there’s one more hoop to go through. You need to know whether your employer is “self insured” or not. Normally an employer buys insurance and pays a monthly premium for your coverage (you may pay a portion of that monthly fee through payroll deduction). The insurance company pays all of the medical bills for insured employees. If employees have a large amount of medical bills that exceed the total of the monthly premiums collected by the insurance company, the insurer is “at risk” and payss the difference. Some large companies prefer to hold the risk themselves and contract with insurance companies only to administer their insurance plan (i.e. handling enrollment and paying health care providers for services rendered, with the company’s money). This is referred to as a self insured plan. Your benefits representative will also know if your plan is self or fully insured.

Read more about different types of insurance plans

Consumers and providers have increased protections because of the new Federal Parity Law, but it is up to all of us to take advantage of these rights and hold insurers accountable. If you, a loved one, or client are not receiving care that is needed, Take Action and file an appeal with your insurer or a complaint with the proper government agency. You can do this on your own following the steps below, or Contact Us for help.