In a self-insured (or self-funded) plan, the costs of medical care are borne by the employer on a pay-as-you-go basis. There is no true "insurance". The employer or union (known as the plan sponsor) decides what services are covered. The employer may contract with a managed care organization only for the process of paying claims. Rules governing self-funded plans fall under federal ERISA (Employee Retirement Income Security Act) law and are not controlled by state legislation. Your rights to appeal may be different. If you are not sure if your employer or union is self-insured, ask your benefits manager or union representative. You may also contact the federal Department of Labor, which regulates self-insured plans.
In Connecticut, all your questions or claims issues should be forwarded to:
U.S. Department of Labor
Pension & Welfare Benefits Administration
Boston Regional Office
JFK Federal Building, Room 575
Boston, MA 02203