What is a fiduciary?

My HR person said they cannot do an override because it is a fiduciary on our plan. How can I tell if this is a self funded plan? Nothing in the certificate of coverage says that this is self funded? I UHC choice plus help please.

Fiduciary usually refers to claims fiduciary. This normally applies to self-funded employer groups. The group can either have the insurance company act as the fiduciary (for a fee) or do this themselves. Also in some cases the fiduciary duties are split between medical and ancillary coverages. It's really just a fancy way of saying who administers the claims. But it normally only applies to self-funded groups.

Look in your Summary Plan Description booklet under APPEALS. It should say who the designated Fiduciary is, and give an address too.

Your company pays for part of your plan (i.e. they are a fiduciary/Trustee on your plan) therefore your plan is not self-funded. I'm going through the exact same thing right now with UHC Choice Plus. They do have an exclusion written into the policy - however, when medically necessary they can override it. It may take a few appeals though. That said, they tend to deny the vast majority of cases. If someone tells you to ask for a rider on your employer's policy, they won't do it. It costs a lot for a company to put a rider on a policy (which would exclude Bariatric Surgery from UHC's exclusion list - aka it would make it okay), and most companies can't afford that cost without pushing it onto the employees, which the majority are loathe to do. I work for a company that deals with insurance and we have a department dedicated to creating and implementing health/dental/vision/disability and life policies for companies and individuals, hence me knowing a lot about the intricacies of this. It's nice to know the details but it sucks when it's against what you are trying to achieve.

When you say they can override it do you mean UHC or my employer?

UHC would override the exclusion if it was deemed medically necessary as long as the exclusion doesn't specifically state "Exclusions: Surgical and Non-Surgical treatment of obesity including morbid obesity, even when medically necessary."