ERISA Topics Page

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. The Patient Protection and Affordable Care Act (PPACA) added additional regulations to the ERISA program. It is administered and enforced by the Labor Department’s Employee Benefits Security Administration, the Treasury Department’s Internal Revenue Service, and the Pension Benefit Guaranty Corporation.  ERISA ensures that participants have access to information about their plans by requiring transparency and accountability.

Many healthcare providers do not take advantage of the opportunities afforded them through the ERISA appeals process.

You need to understand the following concepts:

  • Self-Funded vs Fully-Funded plans: Because some self-funded plans are exempt from both ERISA and the PPACA, it is very important to determine the exact type of plan. Using a Verification of Insurance form (Resource 148) can help. The number of self-funded plans seems to be increasing because of the PPACA.
  • ERISA Appeal steps: These steps include obtaining the summary plan description (SPD), becoming the authorized representative and understanding appeal rights.

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