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#What Is ERISA and What Does ERISA Law Cover?

Who Administers ERISA?

Complaints, concerns, and questions about ERISA laws should be directed to your local office.

Who Must Abide by ERISA Law?

The protective laws under ERISA only apply to private employers (non-government) that offer employer-sponsored health insurance coverage and other benefit plans to employees. ERISA does not require employers to offer plans; it only sets rules for benefits that an employer chooses to offer.

ERISA laws do not apply to privately purchased, individual insurance policies or benefits.

What Are Provisions Under ERISA?

According to TASC, a well-known third-party plan administrator, ERISA regulates and sets standards and requirements for:

• Conduct: ERISA rules regulate the conduct for managed care (i.e. HMOs) and other fiduciaries (the person financially responsible for the plan s administration).
• Reporting and Accountability: ERISA requires detailed reporting and accountability to the federal government.
• Disclosures: Certain disclosures must be provided to plan participants (i.e. Plan Summary the clearly lists what benefits are offered, what the rules are for getting those benefits, the plan s limitations, and other guidelines for obtaining benefits such as obtaining referrals in advance for surgery or doctor visits);

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Other Areas Addressed Under ERISA

ERISA has been amended to include two additional areas that specifically address health insurance coverage. These laws are: