Series
Regulatory and Legal Structure
Self-funded plans exist outside state insurance regulation under federal law. They do not exist outside regulation. ERISA preemption, ACA carve-outs, CAA compliance obligations, mental health parity enforcement, HIPAA requirements, and an evolving state regulatory landscape create a compliance architecture that most small employers sponsoring level funded plans have not mapped. The series covers each layer, where enforcement is active, and where the regulatory environment is moving.
LFP-03.01
ERISA Preemption and Self-Funded Plans: What the Federal Shield Actually Covers
The level funded market rests on six Supreme Court decisions that interpreted three sentences in ERISA section 514. The case law from Shaw (1983) through Gobeille (2016) defines …
LFP-03.02
State Regulation of Level Funded: The Patchwork That Shapes the Market
States cannot regulate self-funded plans directly, but they can regulate stop loss insurance as aggressively as they choose. A state that raises minimum specific attachment points …
LFP-03.03
ACA Compliance for Level Funded Plans: What Applies, What Does Not, and Where the Confusion Lives
Self-funded plans are exempt from ACA community rating, essential health benefits mandates, and medical loss ratio requirements. They are not exempt from preventive care …
LFP-03.04
The CAA and Price Transparency: The Compliance Obligations Most Employers Are Ignoring
The Consolidated Appropriations Act of 2021 created four specific compliance obligations for self-funded plan sponsors: complete broker compensation disclosure, annual prescription …
LFP-03.05
Mental Health Parity in Self-Funded Plans: The Enforcement Wave and What It Requires
The Mental Health Parity and Addiction Equity Act requires covered self-funded plans to perform and document comparative analyses of non-quantitative treatment limitations, …
LFP-03.06
HIPAA, DOL Enforcement, and Audit Exposure: What Plan Sponsors Need to Survive Scrutiny
The employer who sponsors a level funded plan is an ERISA fiduciary with personal liability for how the plan is administered. HIPAA privacy and security rules apply. Required plan …
LFP-03.07
The Regulatory Horizon: Where Federal and State Policy Is Moving on Self-Funded Plans
Federal legislative proposals would extend ACA requirements to self-funded plans or restrict ERISA preemption. State legislatures in multiple jurisdictions are considering measures …
LFP-03.TD1
State Regulatory Map: How Each State Treats Level Funded Plans
A state-by-state reference covering how each jurisdiction treats level funded plans: whether it accepts ERISA preemption without additional restriction, regulates stop loss in ways …