Self-Insurance Is Exempt from State Autism Mandates

In Morgantown, WV, the Dominion-Post reports on a mandate loophole that leads to inequality:

While the new autism insurance law took effect in June, many employees and their families still aren't covered -- including those at WVU Hospitals (WVUH).

"Since WVU Healthcare's WVU Hospitals is a private employer, our health insurance plan is selfinsured and we are exempt from the autism legislation," said Charlotte Bennett, vice president of Human Resources for WVU Healthcare.

This means that nurses and other hospital staff aren't covered. But doctors are -- they work for WVU, a public university, and are insured by the state Public Employees Insurance Agency.

The self-insured loophole is the result of ERISA, which preempts state regulation of self-insured plans.

The US Department of Labor reports:

The Form 5500 data show that slightly more than 50,000 health plans filed a Form 5500 for 2009, an increase of almost 7 percent from the approximately 47,000 health plans that filed a Form 5500 for 2008.4 Of health plans filing a 2009 Form 5500, about 14,800 were self-insured and approximately 6,300 mixed self-insurance with insurance (“mixed-insured”). Self-insured plans covered approximately 24 million participants in 2009 and held assets totaling about $38 billion. In 2009 there were nearly 26 million participants covered by mixed-insured group health plans; these mixed-insured group health plans held more than $81 billion in assets. The table below summarizes aggregate statistics for self-insured and mixed-insured health plans filing a Form 5500 for 2008 and for 2009.