Question

What law does a "fully insured" plan follow?

A fully insured plan always follows state law and is under the oversight of the state’s insurance commissioner of the state in which the plan was sold, not the state in which the patient lives or the state in which the service was provided. For example, if a small business located in the state of South Carolina purchases a fully insured group plan, but the employee lives in North Carolina and actually receives dental treatment by a provider located in Virginia, the South Carolina insurance laws apply to this insured plan. Self-funded plans are subject to federal law (ERISA) and are not subject to state law or the oversight of the state insurance commissioner.