Is my employer health plan self-funded, and how do I find out?
Type your employer's name into Apellica's Form 5500 lookup: if the filing reports the plan funded from general assets or a trust with no health insurance carrier, the medical benefit is self-funded and federal ERISA rules govern the appeal; if a health carrier is listed, it is insured and your state's rules also apply. The Summary Plan Description settles any doubt, and small insured plans, government and church plans do not file at all.
What to do, in order
- Step 1
Look up the employer
Use the legal name from a pay stub or W-2. The result shows the funding verdict, the plan administrator's address and the carriers on file.
- Step 2
Confirm on the ID card or SPD
An insurer's name on the card usually means insured; an administrator's name (often with 'administered by') usually means self-funded.
- Step 3
Follow the matching rules
Self-funded: ERISA claims procedure, federal external review, claim-file request to the administrator. Insured: the same plus state deadlines and state external review through the insurance department.
The deadline that applies
At least 180 days to file an internal appeal on either kind of employer plan (29 CFR 2560.503-1). External review: federal process for self-funded plans, state process for insured plans (45 CFR 147.136).
Calculate your date →Documents to gather
- Employer legal name and state
- Insurance ID card
- Summary Plan Description, if you have it
Go deeper
Related questions
The lookup found my employer but says 'mixed'. What does that mean?
The filing lists a health carrier and also reports general-assets or trust funding. Usually the medical benefit is insured and other benefits are self-funded, or the plan is level-funded. Ask HR which applies to medical.
Why does it matter for an appeal?
It decides which deadlines, which external reviewer and which regulator apply, and whether state consumer-protection law reaches your plan.
Sources
Share your denial and ask our team about appeal preparation and filing support. $0 upfront. Review the fee and terms before deciding. Apellica is not a law firm and cannot guarantee an outcome.
Start a free denial review →