Who regulates insurance plans?
It helps 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 contacting the government group that regulates the health plan to find out if they can give you more information or extra help. Here’s how to start:
- Private group plans (or fully insured plans) that employers purchase from insurance carriers as a benefit for employees are usually overseen by your state’s insurance commission or department of insurance. You can find this department in the blue pages of your phone book, search for it online on your state government website, or contact the National Association of Insurance Commissioners.
- Self-funded plans (or self-insured plans) are health plans that employers or unions create just for their employees and their families. They’re overseen by the US Department of Labor’s Employee Benefits Security Administration. You can ask your employer if your group health plan at work is 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 give you specific information about health plans.
- Medicaid is a joint program that’s 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.
See the “To learn more” section to get contact information for these different groups.
- Covering the costs of cancer treatment
- Private health insurance options
- Types of private health plans for children
- How to manage your child’s health insurance
- Getting answers to insurance-related questions
- Keeping records of your child’s insurance and medical costs
- Handling a health insurance claim denial
- Keeping employer-sponsored health insurance coverage
- Government-funded health plans
- Who regulates insurance plans?
- Options for uninsured children
- What sources are available to help with treatment costs if my child doesn’t have insurance and there’s no public assistance available?
- Financial issues for families: Getting help with living expenses
- To learn more
Last Medical Review: November 13, 2014 Last Revised: January 8, 2015