The largest, enacted in 1988, is a 13 percent surcharge on hospital bills that is paid only by commercial insurers and self-insurance plans.

Nearly half of all workers in private industry now have coverage through such self-insurance plans.

The agency sought to "pool" resources of the charters to develop a self-insurance plan.

But he still needs to buy backup insurance to cover costs if expenses exceed the amount his company has allocated in its self-insurance plan.

About two-thirds of the Amish in Pennsylvania's Lancaster County participate in Church Aid, an informal self-insurance plan for helping members with catastrophic medical expenses.

"Americans, especially those covered by self-insurance plans, ought to be outraged," he said in an interview.

She said the district entered into an illegal self-insurance plan for dental care and drug prescriptions from February 1986 to June 1987 and lost $1.2 million, primarily thorugh payment of premiums for terminated or ineligible employees.

It would eliminate the middleman, converting deposit insurance into a true industrywide self-insurance plan.

Several other companies are also pushing in, and in some cases, doctors are considering self-insurance plans.

It invites complaints and lawsuits, and also more governmental regulation of the many corporate self-insurance plans like Circle K's.