How should the insurer and employer information for claims that are covered by a self-insured pool be reported?
The pool’s FEIN and name should be reported under insurer FEIN (DN6) and insurer name (DN7). The employer’s FEIN and name should be reported under employer FEIN (DN16) and employer name (DN17) and the self insured indicator (DN24) should be set to “Yes.” Only the pool’s information should be reported on the trading partner’s insurer/claims administrator ID list. It is not necessary to include all employers in the pool on the ID list. More information on self insurance plans can be found at http://www.dir.ca.gov/sip/sip.html.
