Self-Funded Plan Considerations

2025-05-06

On this episode of Comply on the Fly, host Karen B covers the core compliance considerations for employers moving from a fully insured to a self-funded health plan. While self-funding can offer greater cost control, it also brings added compliance responsibilities. Karen walks through high-level obligations under ERISA, HIPAA, and the ACA—such as the need for updated plan documentation, direct handling of PHI, and obligations like PCORI fee payments and 1095-C reporting. She also touches on new transparency r...

On this episode of Comply on the Fly, host Karen B covers the core compliance considerations for employers moving from a fully insured to a self-funded health plan. While self-funding can offer greater cost control, it also brings added compliance responsibilities.

Karen walks through high-level obligations under ERISA, HIPAA, and the ACA—such as the need for updated plan documentation, direct handling of PHI, and obligations like PCORI fee payments and 1095-C reporting. She also touches on new transparency requirements, including prescription drug data reporting and gag clause attestations.

If you're exploring or implementing self-funding, this episode offers a helpful compliance overview to keep you on track.

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Please note: This podcast and the contents herein do not constitute legal advice. Seek the advice of counsel for any benefit compliance related implementation guidance or strategy.

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