Health Insurance and Financial Assistance for the Cancer Patient

+ -Text Size

TOPICS

Who regulates insurance plans?

The private group plans (or fully insured plans) purchased from insurance carriers by employers as a benefit for employees are usually overseen by the insurance commissioner or department of insurance in each state. You can find your state’s insurance department in the blue pages of your local phone book, or contact the National Association of Insurance Commissioners (see the “To learn more” section for contact information).

Self-funded plans (or self-insured plans) are health plans that employers or unions create just for their employees and their families. They are overseen by the US Department of Labor’s Employee Benefits Security Administration. (See the “To learn more” section for the website and phone number.) You may have to ask your employer if their health plan is fully insured or self-insured.

Individual plans sold through the health insurance marketplaces are regulated by a marketplace board in every state. This state board oversees the function of the marketplace and the plans sold within it.

Managed care plans are regulated by several state and federal agencies. Your state insurance commissioner or department of insurance can provide specific information about an individual plan.

Medigap policies (Medicare Supplement Insurance policies) are regulated by federal agencies, as well as some state laws. Contact the Centers for Medicare and Medicaid Services (CMS) and/or your state department of insurance for information.

Medicaid is a joint program that is controlled by your state health department and the federal Centers for Medicare and Medicaid Services.

Medicare is run by the federal Centers for Medicare and Medicaid Services.

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.

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.


Last Medical Review: 12/31/2013
Last Revised: 09/08/2014