ClearCarePulse › Care Rights › Self-Funded Plan Routing

Self-funded employer plan: your protections are the same, your complaint address is not

The answer: 45 CFR §149.30 ("specified State law") — a state surprise-billing law can govern the PAYMENT method for state-regulated (fully-insured) plans, but SELF-FUNDED employer (ERISA) plans are federally governed regardless of state law. Patient-side protections apply either way; which law controls the paperwork depends on plan funding.

Where the complaint actually goes

States enforce first; CMS enforces where a state does not. Complaints: cms.gov/nosurprises — the federal No Surprises Help Desk (phone published on that page; commonly cited 1-800-985-3059 [SEARCH-GROUNDED])

Practically: if your plan is self-funded (ERISA), your state insurance department cannot enforce against it — the federal complaint path is cms.gov/nosurprises. If your plan is fully-insured (including marketplace plans), your state regulator enforces first, with CMS as backstop.

How to tell which you have

Your plan documents (Summary Plan Description) or HR will state whether the plan is self-funded/self-insured (employer bears the claims risk, an insurer just administers it) or fully-insured (the employer buys a policy from an insurer). This does not change whether you're protected from balance billing — only who you complain to.

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Generated 2026-07-07 by ClearCarePulse (The Aslan Group LLC) from the same source-cited legal reference data our paid engine uses. Informational, not legal or medical advice — rules change; verify with the cited CFR/USC sections. Contact: info@theaslangroupllc.com