Health plan & appeal guide
Simpson Senior Services
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 says benefits are paid from the employer's general assets.
- Medical insurance bought from Blue Cross Blue Shield is on file, covering about 30 people.
- We ignored a small insurance contract with Amerihealth covering about 1 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 17% of the 178 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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Know your deadlines
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What happens next
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