Health plan & appeal guide
Kennedy Pavilion RH LLC Dba Pavilion at Queens Rehab and Nursing
The filing doesn’t settle it. One question about your insurance card will.
How we know · low confidence
- No medical insurance contract is on file (Schedule A).
- The filing says all benefits are paid through insurance contracts.
Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.
Is your plan insured or self-funded?
Look at your card or plan summary, or ask HR: “Is our medical plan fully insured or self-funded?”
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This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.
How we know · medium confidence
- The filing lists stop-loss insurance (Everest Reinsurance). Employers buy stop-loss only when they pay claims out of their own money.
- Medical insurance bought from Empire Healthchoice Assurance is on file, covering about 0 people.
- The filing says all benefits are paid through insurance contracts.
- Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
- The insured options cover only about 0% of the 140 participants, so most people in this plan are in the self-funded part.
- The self-funded part's claims are processed by Anthem (Schedule C).
Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.
Which company is on your insurance card?
It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.
Send your appeal here
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Know your deadlines
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What happens next
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Get free help
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