Who regulates insurance plans?

The private group plans (or fully insured plans) purchased from insurance carriers by employers as a benefit for employees are overseen by the insurance commission 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 “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 are overseen by the US Department of Labor’s Employee Benefits Security Administration. (See the “To learn more” section for the Web site and phone number.) You may have to 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 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 Medicare (CMS) and/or your state department of insurance for information.

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.

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.