The bill does not cover individuals who are insured through employers that have self-funded plans.

In 2009, federal legislation was introduced in both chambers of the United States Congress to require self-funded plans to offer autism benefits.

Q. Many big companies are reacting to premium increases by turning away from H.M.O.'s and toward their own self-funded plans.

The family's primary health insurance was Ms. Wiser's coverage under her employer's self-funded plan administered by UnitedHealthcare's Dallas office.

And Trustmark Life Insurance Company insures the fully insured plans and provides stop-loss insurance for the self-funded plans.

Star Marketing and Administration, Inc (Starmark) administers PPO-based fully insured and self-funded plans to small businesses and their employees.

The state regulations do not apply to these self-insured plans, which are offered by many of the country's biggest employers.

Such self-insured plans are subject to federal regulation.

Most big companies and a growing number of small ones have self-insured plans, most often administered by an insurance company or health maintenance organization.

Self-insured plan: a group health plan where the employer assumes the risk of paying the benefits itself.

Unions and employers whose self-insured plans are federally regulated have also denied coverage in some cases.

Companies providing health insurance for their employees through a self-insured plan often subscribe to stop loss policies in order to protect themselves against catastrophic claims.

Such self-insured plans, which are financed by employers rather than purchased from a state-regulated insurer, have caused problems for couples.

An insurance company may provide administration services to a self-insured plan, such as claims administration, but does not assume any risk to pay claims for benefits.

Sharon Mayhak said she was denied coverage by her partner's employer, which has a self-insured plan, so she remains without insurance despite bad arthritis.

In a similar case in Texas, a self-insured plan capped an employee's benefits after he began filing claims for treatment of AIDS-related conditions.

The Supreme Court ruling did not apply to self-insured plans in which large and midsized employers assume the risks of paying for any medical bills their employees may incur.

A 2006 report by the Human Rights Campaign Foundation found that more than half the Fortune 500 companies, most of which have self-insured plans, offered benefits to domestic partners.

Generally, the consumer protections in the Republican proposals would apply only to federally regulated health plans in which employers directly assume the financial risks for workers' medical care, so-called self-insured plans.

That was the year of enactment of the Employee Retirement Income Security Act, known as ERISA, which exempted self-insured plans from both mandated benefits and state insurance premium taxes.

Phelps is also one of seven Westchester and Connecticut hospitals in a newly formed network known as the Excel Care system, which is being marketed as a managed-care network to corporations and self-insured plans.

Because self-insured plans are regulated by the Federal Employee Retirement Income Security Act, and Federal law takes precedence over state law, employees who belong to these plans are not guaranteed the 48-hour maternity care.

The cost of all the tests and the surgery totaled about $10,000, 80 percent of which was paid by the Milwaukee Graphic Arts Health and Welfare Fund, a self-insured plan provided through Mr. Cler's union.

Norman Black, a spokesman for United Parcel Service, said that the company had offered benefits to domestic partners of its nonunion workers since 2004, but that hourly workers like Ms. Brazier were covered by the Teamsters under a self-insured plan.

Other financing would come from gradually increasing the Federal tobacco tax, now 24 cents a pack, to 69 cents a pack, by imposing a 2 percent tax on health insurance premiums and the expenses of self-insured plans andfrom slowing the rate of growth in Medicare.

At General Motors, for example, spending on drugs increased 20 percent last year, to $762 million, in its self-insured plans, and the company expects its pharmacy costs to continue rising at that rate, said Bruce Bradley, director of managed-care plans at G.M.

In general, these laws do not apply to insurance plans financed by the employer - as opposed to plans in which the employer buys coverage from an insurance company - because self-insured plans, favored by some larger companies, are shielded from state rules and laws under the 1974 federal Employee Retirement Income Security Act.