An ASO health plan is a self-funded arrangement in which the employer contracts with a carrier or third-party administrator (TPA) purely for administrative functions, claims processing, network access, and reporting, while the employer itself retains the financial risk. This is how roughly 80% of large-employer covered workers access a national carrier's network without transferring the underlying claims risk.
ERISA and the DOL govern the underlying plan, while state regulators retain authority only over the stop loss coverage layered on top, a consequence of ERISA's "deemer clause." Carriers offering ASO arrangements can also embed solutions like the CareStation as a plan benefit, making them a distinct sales channel alongside the employer and broker.
The employer carries the claims risk. The carrier or TPA in an ASO arrangement is responsible only for administrative functions like claims processing and network access, not the underlying financial risk.
Both, but for different pieces: ERISA and the Department of Labor govern the underlying self-funded plan, while state insurance regulators oversee any stop-loss insurance the employer purchases alongside the ASO arrangement.
Every term here points to the same gap in healthcare access. See how the CareStation closes it.
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