ERISA–Employee Retirement Income Security Act — 1974
ERISA requires plans to provide participants with plan information including important information about plan features and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty.
In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans. (Department of Labor’s Web Site) * poynerspruill.com
- Health Benefits Advisor interactive Website assists employers in understanding and complying with federal group health plan laws
- Health Benefits Laws Self Compliance Tools
- Reporting/Disclosure Guide For Employee Benefit Plans – A quick reference tool for certain basic reporting and disclosure requirements under ERISA
- Understanding Your Fiduciary Responsibilities Under A Group Health Plan provides an overview of the basic fiduciary responsibilities applicable to health plans under ERISA
COBRA (Consolidated Omnibus Budget Reconciliation Act) provides some workers and their families with the right to continue their health coverage, in general for 18 months after losing their job. See also Cal COBRA, which provides a total of 36 months for CA Residents.
HIPAA (Health Insurance Portability and Accountability Act) provides important protections for working Americans and their families who have preexisting medical conditions or might otherwise suffer discrimination in health coverage based on factors that relate to an individual’s health.
CNA Third Party ERISA coverage reimburses covered plans for loss due to fraud by a trustee, officer, employee, administrator or a manager including administrators or managers who are independent contractors
Technical & Research Resources
USC (United States Code) Chapter 18 ERISA
ERISA Enforcement, Civil & Criminal DOL Site
Sec. 1182 ERISA . – a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors
Sec. 1182(b) (1) In general A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individuals see also AB 1672