Health plan & appeal guide
PWC US Group LLP
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.
- We ignored 1 low-cost supplemental policy(ies) such as accident or hospital cover; they don't decide how your medical claims are handled.
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 says benefits are paid from the employer's general assets.
- Medical insurance bought from Triple-S Salud is on file, covering about 177 people.
- We ignored a small insurance contract with Cigna, UnitedHealthcare covering about 144 people; it is too small to be the main plan.
- 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 44,229 participants, so most people in this plan are in the self-funded part.
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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What happens next
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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 says benefits are paid from the employer's general assets.
- Medical insurance bought from Sierra Health And Life Insurance Company is on file, covering about 5,564 people.
- Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
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
Unlocks after you answer the question above
Know your deadlines
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What happens next
Unlocks after you answer the question above
Get free help
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