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Employer coverage

Most large employer plans are self-funded and governed by federal ERISA rules.

Step by step

  1. 1Ask HR whether the plan is self-funded — it decides who regulates your appeal.
  2. 2Request the Summary Plan Description and the full claim file, which ERISA entitles you to.
  3. 3The Department of Labor's EBSA benefits advisors help at no cost.
Before you move on

Write down who you spoke with, the date, and what they promised. A short dated note is the single most useful thing you can have if this issue has to be escalated later.

Ask Phoenix about this
Explain employer coverage in simple terms.What should I say when I call?What happens if they say no?

Educational purposes only

Phoenix Health Compass does not provide legal advice or medical advice. This content summarizes publicly available government and nonprofit resources and is cited throughout. Always confirm requirements, deadlines, and forms with the official agency.

Last reviewed by the Phoenix Health Compass editorial team.