Your coverage

Job-based plans

Coverage through an employer or union, whether the employer funds it or buys it from an insurer.

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Your path depends on whether your employer pays claims itself (self-funded) or buys insurance (fully insured). Find that out first.
You get at least 180 days after you receive the denial to file the plan's own appeal. Independent review has its own window, at least four months after the final denial.
You can ask for the claim file and plan documents in writing before you appeal, and the plan cannot charge you to appeal.
Check the date on your notice, which controls. Your plan may allow more time than the federal minimum, never less.

Each page has the appeal steps, deadlines and free help for that coverage.

Employer plan the employer funds itself (self-funded)
Your employer pays your claims from its own money, often with an insurance company handling the paperwork. Federal law governs the plan, so the Department of Labor, not your state, is the agency to call.
Employer plan bought from an insurer (fully insured)
Your employer buys a policy and the insurance company pays your claims. You have federal appeal rights and your state insurance department and state external review process, so you have more places to turn than with a self-funded plan.
State or local government employer plan
Your employer is a state, county, city or school district. Federal employer-plan law does not apply, but Affordable Care Act appeal and independent review rules do, unless the plan is grandfathered. The agency that helps depends on how it is funded.
Church plan
A health plan run by a church is usually outside the federal employer-plan law unless the church chose coverage. Federal appeal rules may still apply through the tax code, but who enforces them is less clear. Read your notice closely.

More guides, tools, letters 10

Employer plans: the complete appeal path
The whole path for a denial from a job or union plan. It runs from the plan's appeal to independent review, the agency to call, and the court option.
Fully insured employer plans and state protections
If your employer buys insurance for you, both federal law and your state's insurance rules apply. Here is what that adds, who to call, and how to find out which kind of plan you have.
Government and church employer plans
Plans run by state and local governments, school districts and churches are outside much of ERISA. Learn which federal rules still protect you, which do not, and who to ask.
Two plans at once and COBRA
A short guide to claims stuck between two health plans and to continuation coverage after a job change. It explains what this site can and cannot confirm, and who to ask.

Tool

Coverage type finder

Work out what kind of plan you have and who regulates it, even if you are not sure.
Tool

Employer escalation builder

Build a request asking your employer's benefits team to step in, with a script for the conversation.

Letter or script

Ask your employer to review the denial

A polite written request to your employer's benefits office to look into a denial, name the plan administrator and send the plan documents.
Letter or script

Phone script: talk to human resources

What to ask your employer's benefits or human resources office to learn who runs your plan and to get the plan documents.

Run by other organizations.

Questions to keep handy

Your notice or plan document controls if it differs from a general rule. Keep a copy of everything and the date and way you sent it.

Sources last checked 12 November 2026. Found a mistake? Report it.