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 Posted: Mon Aug 02, 2010 11:52 am Post subject: Self-insured health plan |
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| I have opted for a self-insured group health policy at my work place. I'd be grateful if you can inform me about how to file a claim under this plan. |
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ArindamSenIndies
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| Posted: Wed Aug 04, 2010 10:23 am Post subject: |
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| I'm not sure if your self-insured plan assumes the whole risk or not. Onething I can assure you is that you'd need to follow procedures set under the U.S. DOL (Dept. of Labor). |
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steven
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| Posted: Wed Aug 04, 2010 12:34 pm Post subject: |
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Employees who have self-insured health plans are protected under the ERISA. So, don't contact your state insurance dept. in case you meet with a problem regarding such plans.
State insurance laws are only meant to govern typical individual or group health plans. |
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roddick
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| Posted: Thu Aug 05, 2010 5:31 am Post subject: |
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Once you get enrolled into a self-insured health plan, you'll find a document called Summary plan description. This document is very important to you, as you'll find your ERISA rights over here. It will help you understand the way your plan works, it's benefits and the ways to achieve them.
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Juanita
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| Posted: Fri Aug 06, 2010 9:05 am Post subject: |
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| Quote: | | It will help you understand the way your plan works, it's benefits and the ways to achieve them. |
For all plans that are governed by ERISA, you'll need to follow certain procedures to file your claims. You'll come across such information in the SPD.
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sil
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| Posted: Sat Aug 07, 2010 9:22 am Post subject: |
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Dear friend, please note that in order to achieve the benefits of these plans you must meet some standards. For that you'd need to go through the plan docs.
Your plan might need you to inform your plan administrator as soon as you get admitted to a hospital. Under some plans, you might need to pay your medical bills out-of-pocket, and then get a reimbursement for the same from your carrier. |
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JeremyHolter
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| Posted: Sat Aug 07, 2010 5:09 pm Post subject: |
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Your company's "self-funded" health plan is most likely being administered by a Third-Party Administrator. If you don't know how your plan operates, you should contact the benefits person at your company and ask. The worst that can happen is they give you the toll-free phone number to the TPA and you can discuss it with them directly.
Before you even enrolled, all of this was supposed to be disclosed to you. Were you asleep? What did you miss?
Although the conduct of the TPA is governed under state law, the health plan itself is operated under the auspices of both state and federal laws. The US Dept of Labor's Employee Benefits Security Administration oversees the enforcement of the ERISA laws that apply.
Follow this link for more information about "Health Plans" on the DOL website:
http://www.dol.gov/dol/topic/health-plans/index.htm
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MaxHerr
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| Posted: Sat Aug 21, 2010 11:33 am Post subject: |
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hi,
you are open the health insurance policy website ,where you open insurance.and read how to file a claim under the plan.second way you asked insurance agent.
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igorvolseo
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