A self-insured plan may seem just like traditional insurance to you, but it does not always work the same way. And the differences can be important. Of course, as long as claims are being paid you may not notice whether your employer is fully insured or self-funded. Find out how your health plan works All self-insured employer plans do not work exactly the same way. Your plan's details are explained in your benefits handbook.
Some insurance companies contract as TPAs.
This can disguise the facts if your plan is self-funded. A self-funded employer takes on the roles the insurance company usually plays. These roles can include paying claims, deciding on benefits, and determining which claims to pay. TPAs simply follow the employer's orders. If your claim is denied Self-funded plans usually have an internal process to review claim denials.