About 175 million people are covered by an employee health plan through their job or the job of a loved one. More than half of people in employee health plans work for an employer that is self-insured or partially self-insured. Self-insured plans are ones that are subject to federal law rather than the patchwork of state regulations that insurers must follow. When employers self-insure, they take on the risk of their employees medical needs and generally have stop loss coverage to guard against any one worker or dependent have exceptionally high medical bills. Whereas insurance is somewhat of a stodgy business, employers themselves are looking for solutions rather than premium hikes year-after-year. Most of the innovation that occurs in health coverage are experiments being conducted by self-insured employers. These include decision-support tools to make enrollees more informed consumers of medical care. Employers are dumping a ton of money into employee Health & Wellness programs, health risk assessments and chronic disease management. A few employer plans, like North Carolina-based like HSM Solutions, are outsourcing some medical care for high cost procedures to countries abroad. CalPERS, the public employee union, has initiated experiments in reference pricing to provide beneficiaries an incentive to seek out lower-cost providers. These are all examples of self-insured plans looking for solutions to the problem of high medical costs.