ERISA and its impact on your health plans

Many health plans in the private sector are under the umbrella of the Employee Retirement Income Security Act, or ERISA, which is a federal tax and labor law. It originally outlined the minimum standards for private industry pension plans. Today, ERISA is a major advocate for the members and families of Colorado employee benefits plans.

Who is covered under ERISA?

ERISA enforces laws via the U.S. Department of Labor. The law governs employer-sponsored health insurance reporting, documentation and fiduciary requirements. Nationally, somewhere in the vicinity of 140 million employees and their beneficiaries use an ERISA-governed health plan.

ERISA doesn’t cover plans set up through governmental entities or churches. It doesn’t cover plans designed to manage worker unemployment, compensation and certain disability laws, nor does ERISA cover international plans that benefit nonresident aliens and unfunded excess benefits.

Types of benefits

Participating in a workplace plan can cover a variety of benefits with plan obligations covered by ERISA. The law safeguards your disability benefits, ensuring that administrators of disability claims treat you fairly. Whether short- or long-term disability insurance claims, ERISA promises appropriate treatment when utilizing your health benefits. ERISA ensures a responsible timeline for a decision and a full understanding of your rights should they deny the claim.

Health benefits covered by ERISA

Your health benefits make all the difference in the world to you and your loved ones. There are three basic types of claims to consider under ERISA:

• Urgent care claims: Urgent care is a special pre-service claim. It’s a plan where you need quicker decisions because of a health threat.
• Pre-service claims: The pre-service claim requests approval for preauthorization or a decision on a necessary medical procedure or treatment.
• Post-service claims: A post-service claim covers all other benefits. This includes after-medical service claims such as payment or reimbursements. The majority of group health benefits are post-service claims.

If you are having trouble making a claim, you may want help from an attorney with experience in ERISA claims. A legal professional may explain your options and offer guidance to help ensure that your claim is successfully submitted.