Is my health plan self-funded?
Type your employer’s name. If it files a Form 5500 for a health plan, you will see whether the medical benefit is self-funded (federal ERISA rules, federal external review) or insured (your state’s rules), the plan administrator’s address for a claim-file request, and the carriers on file. Nothing you type is stored.
68,365 employer health plans on file (27,151 self-funded, 15,832 insured, 23,551 with both signals). Data refreshed monthly from DOL.
- Form 5500 filings lag: a plan year's filing is due seven months after the year ends, so the newest record may describe last year's arrangement.
- Plans with fewer than 100 participants that are insured or unfunded generally do not have to file. If your employer is not listed, that does not mean the plan is insured.
- Government and church plans do not file Form 5500 and are not subject to ERISA.
- A listed carrier can be a third-party administrator, a stop-loss insurer or the dental or vision carrier. The health flag on the filing's Schedule A is what this tool reads.
- The Summary Plan Description and your ID card control. This is public-record information, not legal advice; Apellica is not a law firm.
Source: US Department of Labor, Form 5500 datasets. Apellica loads health welfare plans (code 4A) from the two most recent form years, latest filing per plan.
Questions
Why does it matter whether my plan is self-funded?
A self-funded employer plan is governed by federal ERISA rules: the claims-procedure regulation sets the deadlines and disclosure duties, state insurance law generally does not apply, and external review runs through the federal process or the plan's contracted reviewer. An insured plan is also subject to your state's insurance rules, deadlines and external review through the state insurance department.
How does the tool decide?
It reads the employer's most recent Form 5500 filing. If the filing's Schedule A lists a health insurance carrier (not a stop-loss policy), the medical benefit is insured. If the filing reports funding from the employer's general assets or a trust and no health carrier, it is self-funded. When both appear, the tool says so and shows the carrier, because the Summary Plan Description then decides.
My employer is not listed. Does that mean the plan is insured?
No. Insured or unfunded plans with fewer than 100 participants generally do not file, government and church plans never file, and filings lag by seven months or more. Ask HR for the Summary Plan Description, which must state how the plan is funded.
Where does the data come from?
The US Department of Labor publishes every Form 5500 filing as public datasets. Apellica loads the health welfare plans (benefit code 4A) from the two most recent form years and keeps the latest filing per employer plan. Signer names are not loaded.
Related: Is my health plan self-funded? (the guide) · The plan must show you the rule it used · Do I need a lawyer to appeal?