Who regulates insurance plans?

It’s important to know who regulates a health plan if you have a problem that you can’t resolve directly with the plan. You have the option of talking to the government group that regulates the health plan to find out if they can offer more information or extra help:

• The private group plans (or fully insured plans) that employers purchase from insurance carriers as a benefit for employees are overseen by your state’s insurance commission or department of insurance. You can find this department in the blue pages of your phone book, or contact the National Association of Insurance Commissioners (see the “To learn more” for contact information).
• Self-funded plans (or self-insured plans) are health plans that employers or unions create rather than purchase. They’re overseen by the US Department of Labor’s Employee Benefits Security Administration. (You can ask your employer if their health plan is fully insured or self-insured.)
• Managed care plans are regulated by several state and federal agencies. Your state insurance commission or department of insurance can give you information about a specific plan.
• Medicaid is controlled by your state health department.
• Medicare is run by the US Social Security Administration.
• TRICARE is overseen by the US Department of Defense.
• The Veteran’s Health Care system (including CHAMPVA) is regulated by the US Department of Veteran’s Affairs.