ERISA Benefits Law Desk ReferenceERISA Benefits Tech, LLC

Part 13 · Chapter 5

Which Health Reforms Apply to Self-Insured Group Health Plans

Law stated as of October 3, 2026 · COBRA, HIPAA, and Welfare Benefits

Scope and status

This chapter maps the federal health-reform requirements that apply to self-insured (self-funded) group health plans, distinguishing them from the insured-market rules that do not, and incorporating the post-2021 CAA and transparency layers. Several items are subject to recent rulemaking or litigation, noted below; current regulatory text, effective dates, and indexed amounts should be confirmed before relying on them.

Sections

The first section is shown in full. The other sections are listed by title; their text is available to subscribers.

How to Use This Map

The threshold question for a self-insured plan is which federal reforms reach it at all. Many high-profile ACA "market reforms" are written into the Public Health Service Act (PHSA) and apply to insurance issuers in the insured market; a self-insured plan has no issuer and is subject to the subset of reforms that Congress applied to group health plans directly (incorporated into ERISA and the Code). Layered on top are the Consolidated Appropriations Act, 2021 (CAA) transparency and consumer-protection provisions and related transparency rules, which do apply to self-insured plans. A further cut is the grandfathered versus non-grandfathered distinction: a plan that has maintained grandfathered status is exempt from several ACA provisions, but grandfathered plans are now rare and the status is easily lost.

Work the analysis in three passes: (1) confirm self-insured status and whether any component is insured (a stop-loss policy does not make the plan insured, but an insured component can pull in issuer rules); (2) determine grandfathered status; (3) apply the reform-by-reform map below.

  1. ACA Reforms That Apply to Self-Insured PlansSubscribers
  2. ACA / Insured-Market Reforms That Do NOT Apply to Self-Insured PlansSubscribers
  3. CAA 2021 and Transparency Layer (Apply to Self-Insured Plans)Subscribers
  4. Mental Health Parity (MHPAEA)Subscribers
  5. §105(h) Nondiscrimination for Self-Insured Medical Reimbursement PlansSubscribers
  6. Other Federal Requirements Reaching Self-Insured PlansSubscribers
  7. Two Live Rulemakings to Watch (proposed only — no reliance)Subscribers
  8. Issue-Spotting ChecklistSubscribers

The first Part of each chapter is open to everyone. The remaining sections, with their authority and practice points, are available to subscribers and to clients of ERISA Benefits Law Group, PLLC whose engagement includes access.

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