Health Insurance FAQ Answer
Q:
When I called my state insurance department for help with my employer's self-insured health plan, I was told that the state doesn't handle matters arising from this type of plan and to call the U.S. Department of Labor. Is this correct?
A:
Yes, if your group health plan at work is self-insured (meaning the employer assumes the risk for plan members), the U.S. Department of Labor (DOL) — not your state insurance department — sets procedures to follow when filing a claim or appealing a claim denial. The same state insurance laws that regulate typical group and individual health plans don't protect employees under self-insured company plans.
The DOL staffs 10 regional offices to field both ERISA and COBRA inquiries, as well as questions regarding workers compensation. If you have a question concerning your ERISA health plan, you can contact your nearest DOL office and ask for an ERISA consultant. The consultants are trained to assist and instruct you on how to proceed if you wish to file a complaint against your self-insured health plan or if you want to appeal a claims denial.
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