Chapter 6: Florida Autism Insurance Mandate – Understanding the Self-Insured Plan Exemption (Originally published July 7, 2008)
In this and other Chapters, in a Q&A format, we provide some basic information that we hope will help you answer questions you may have on various topics related to the Florida autism legislation. See Introduction and Table of Contents.
Speaker Rubio estimated that the mandate would cover only 14% of children with an autism spectrum disorder. Sadly, we think this estimate is accurate. See “Q: If these exemptions are so extensive, how many Floridians will the autism insurance mandate actually help?” in Chapter 4. To determine who the mandate will help, you must first understand why the scope of the mandate is so limited. In Chapter 4, we summarize the extensive exemptions to the mandate. In this Chapter, we discuss in more detail the exemption for self-insured plans. In Chapter 7, we outline some steps you can take to determine if your plan is self-insured.
Please keep in mind that we are answering general questions that may or may not apply to your specific circumstances. You should consult a lawyer or other specialist if you think you are entitled to benefits that you do not receive. Behavioral Lifeboat can help you do that.
Q: What is ERISA preemption? How does Federal law (ERISA) prevent Florida from mandating what benefits a health plan covers?
A: See “Q&A: ERISA Preemption – Basic Information.” Federal law (ERISA) generally prevents states from directly regulating any fringe benefit that an employer provides to employees, including health benefits. This exemption from state regulation is generally referred to as ERISA preemption.
Q: What is a self-insured (self-funded) benefit plan?
A: See “Q&A: ERISA Preemption – Basic Information.” Some employer sponsored health benefit plans elect to bear the risk of their employees’ health care costs by directly insuring the benefits with company assets rather than with an insurance policy. These plans are considered self-insured because the employer bears the risk of employees’ health care costs.
Q: How does my employer’s decision to self-insure health benefits affect a state autism insurance benefits mandate?
A: See “Q&A: ERISA Preemption – Basic Information.” Self-insured health plans are exempt from state autism insurance benefits mandates because of ERISA preemption.
Q: How many Floridians are covered by self-insured health plans?
A: See “Q&A: ERISA Preemption – Basic Information.” In 2005, approximately two-thirds of all Floridians who worked for a medium or large employer (50 or more employees) and were insured under that employer’s health plan were enrolled in a self-insured plan.
Q: What motivates an employer to self-insure a health plan?
Q: Will I know if my health plan is exempt from the Florida autism insurance mandate because the plan is self-insured?
Q: How can I determine if my employer has self-insured my health plan without asking my employer?
If you have questions, please comment in the Behavioral Lifeboat blog.
© 2008, 2011 Richard W. Probert