4/1/13 DOL released its third annual report to Congress on Self-Insured Group Health Plans, as required by ACA §1253. The report contains general information on self-insured employee health benefit plans and financial information on the employers that sponsor them. The first report was provided to Congress in March 2011.

The majority of Americans receive their health insurance through their employer or the employer of a close relative. There are several ways in which plan sponsors (usually the employers) may fund the health insurance plans that they offer to their workers. In a self-insured health plan, the plan sponsor generally directly funds the health benefits for its covered enrollees. Self-insured plans can be financed on a pay-as-you-go basis or through contributions to a trust fund established for the express purpose of paying for the claims of the plan's participants and beneficiaries. The plan sponsor may choose to administer its health plan directly or to utilize an outside professional to administer its health plan, typically a Third-Party Administrator (TPA). In contrast, a fully-insured plan is one in which the employer purchases group health insurance coverage through an insurer that assumes the risk of paying the health-care claims of the participants covered under the health benefit plan and performs the plan's administrative functions. Self-insurance is more common among larger employers, mainly because the health expenses of larger groups are more predictable and therefore larger sponsors face less risk.

Self-insured and fully-insured plans are governed by different policies, laws and regulations. State laws that govern group health insurance generally do not apply to self-insured plans. Furthermore, some ACA provisions apply to group health insurance but not to self-insured plans. In Massachusetts, although coverage of certain services is mandated across the fully-insured market; state insurance laws do not apply to the self-funded market. Self-insured group health plans, health insurance coverage offered in the large group market, and grandfathered plans are not required to cover the essential health benefits (§1302). 

Read the April 2013 report at: http://www.dol.gov/ebsa/pdf/ACAReportToCongress033113.pdf