Plan funding screen

    Read the ID card. Then check the state.

    The member card can show whether a carrier funds the plan or only administers it. Use that clue to identify the plan type, then open the applicable state guidance before choosing a state or federal IDR route.

    See ID card examples Open state guidance
    Self-funded member ID card example
    Fully insured member ID card example
    Same carrier family. Different funding clues.

    ID card examples

    Look for who carries the risk.

    Read both sides of the card, including the fine print. The important question is not whose logo appears at the top—it is whether the carrier insures the plan or administers claims while an employer or plan sponsor funds them.

    Sample HealthSelect member card with the claims are self-funded disclosure circled
    01Self-funded signal

    “Claims are self-funded”

    The clearest version: the card directly states that claims are self-funded.

    Sample Surest member card with Self-insured coverage circled
    02Self-funded signal

    “Self-insured coverage”

    Some cards place a short funding label on the front rather than in the fine print.

    Sample Blue Cross Blue Shield card with the administrator no-financial-risk disclosure circled
    03Self-funded signal

    Administrator assumes no financial risk

    The carrier handles claims, but the plan sponsor bears the financial responsibility.

    Sample Blue Cross Blue Shield of Illinois fully insured card with carrier language circled
    04Fully insured example

    Carrier-issued coverage

    This example is fully insured: the Blue Cross entity is the insurer rather than an administrator disclaiming claims risk.

    Do not route from the logo alone. If the card is unclear, confirm whether the plan is self-funded or fully insured through the SPD/SBC, governing plan documents, or the plan administrator or carrier.

    Choose the route

    The card narrows the path. State guidance confirms it.

    Plan funding is one routing fact. The claim still has to fit a protected service category, and the applicable state rules can change the process for fully insured coverage.

    STEP 01

    Refer to the member ID card

    Preserve both sides and record the exact funding language: self-funded, self-insured, administrative-services language, or carrier-issued coverage.

    STEP 02

    Refer to the state guidance page

    Start with the state where the service occurred. Then verify the plan type, facility and provider network status, service category, dates, payer product, and any state-law opt-in before filing.

    Browse state guidance Full eligibility checklist

    Before selecting a route

    • Confirm the service fits a protected No Surprises Act category.
    • Confirm provider and facility network status for the encounter.
    • Confirm whether the plan is self-funded or fully insured.
    • Check the applicable state page, payer product, dates, and deadlines.