When and How to Contact Insurance Regulators

When to go to your state regulators for help

Most states are responsible for enforcing Affordable Care Act (ACA) standards that apply to fully insured health plans, including those sold to individuals and small employers. These standards include the requirement that plans cover Essential Health Benefits and the prohibition on plan designs that discourage enrollment from people with significant health needs. In states that fail to enforce the ACA standards, the U.S. Department of Health and Human Services is responsible for enforcement. See the table below for contact information for state departments of insurance.

You may be required to file an appeal with your insurance plan before seeking state or federal assistance with your issue. Healthcare.gov includes information to help determine when an appeal should be filed with the Marketplace or with an individual health plan: https://www.healthcare.gov/marketplace-appeals/appeal-forms/

When to go to federal regulators for help

A federal law known as ERISA governs employer-sponsored coverage, whether fully insured or self-insured, and enforcement of these rules is carried out by the U. S. Department of Labor (DOL). You can contact the DOL’s Employee Benefits Security Administration (EBSA) at https://www.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa

To find an EBSA contact for your state, see

https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices

State Department of Insurance websites