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Illinois Self Insured Health Plans

Self insured health plans are group insurance and are not to be confused with self employed health insurance. Medequote offers plans from Assurant, BCBSIL, Celtic, Humana, World, and UniCare that are specifically designed for the self employed, individuals and Families. Listed below are Illinois state guidelines, and definitions for Group Self Insured Health plans.

It is estimated that more than half of Illinois residents who have group health coverage through an employer or union are receiving benefits through a single employer self-insured health plan or a self-insured health and welfare benefit plan (union).  Many large employers, unions, government agencies including local municipalities, and school districts are self-insured. 

What Is a Self-Insured Health Plan?

A self-insured health plan is a health benefit plan where the plan sponsor (employer or union) is at risk for the claims incurred by the members of the plan.  This differs from a fully insured health plan where the insurance company assumes the risk for the claims incurred in exchange for a premium.  Self-insured health plans utilize third party administrators (TPAs) to administer claims for the plan.  Many times, the TPA is an insurance company.

Who Regulates Self-Insured Health Plans?

Most self-insured health plans are regulated by the United States Department of Labor, Employee Benefits Security Administration (DOL-EBSA) under the federal Employment Retirement Income Security Act (ERISA).  However, DOL-EBSA does not regulate self-insured plans that are sponsored through school districts, municipalities, and churches. 

• State insurance laws do not apply to self-insured health plans.

What Benefits Must Be Provided By a Self-Insured Health Plan?

Employers and unions have much more flexibility when choosing benefits to offer under a self-insured health plan.  Federal law does mandate some benefits for self-insured health plans.  Members should refer to their member handbook or contact DOL-EBSA for information on those benefits. 

State mandates do not apply to self-insured health plans.  

Give us a call at 800-391-7469 if you have any questions.