Self-funded plan
Updated September 30, 2026
Definition
A job-based health plan where the employer pays claims with its own money, often with an insurer handling the paperwork. State insurance laws generally don't apply to it.
In a self-funded plan, also called a self-insured plan, your employer pays your medical claims with its own money. Many employers hire an insurer or another company to run the plan. That company may process claims and provide the network, so its name may be on your card even though it isn't paying the claims.
This matters when something goes wrong. State insurance laws generally don't apply to self-funded plans covered by the federal Employee Retirement Income Security Act (ERISA). So a state protection you read about may not cover you. Federal protections still apply. The No Surprises Act, for example, covers people with job-based coverage.
To find out which kind of plan you have, check your plan documents or ask your human resources office. Look for words like "self-funded," "self-insured," or "administered by." Knowing the answer tells you which rules and which regulator to turn to if you need to appeal.
Related terms
Guides that use this term
Sources
- Self-insured plan (glossary), HealthCare.gov. Accessed September 30, 2026.
- Annual report on self-insured group health plans (2023), U.S. Department of Labor, Employee Benefits Security Administration. Accessed September 30, 2026.
- Know your rights: using health insurance (No Surprises Act), Centers for Medicare & Medicaid Services. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.