Health Benefits

Providing health benefits to your employees is a highly regulated undertaking, and it’s a good idea to get the lay of the legal landscape. The following is an overview of a few of the major laws affecting health insurance plans offered by employers.

Federal benefits laws include:

ERISA. The main purpose of the Employee Retirement Income Security Act (ERISA) is to protect employees from losing their pensions due to harsh vesting rules or poor management, but the law also covers health benefits and has extensive reporting and disclosure requirements for all applicable employee benefit plans.

ACA. The enactment of the Affordable Care Act (ACA) in 2010 began an extended period during which far-reaching changes to the American healthcare system started to take effect. Important provisions bar preexisting condition restrictions, require coverage of dependents to age 26, bar cost sharing for preventive care, encourage wellness programs, require individuals to obtain qualifying health coverage or pay a yearly financial penalty, and require employers with 50 or more employees to offer health insurance coverage or be assessed fees.

COBRA. The Consolidated Omnibus Budget Reconciliation Act (COBRA) was designed to protect employees and their families from losing health benefits if the employees lost their jobs.

HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that imposes portability, nondiscrimination, and other requirements on certain employer-sponsored health plans. There are also regulations covering how employers must protect employees’ medical privacy rights as well as the electronic disclosure of employees’ medical information.

FMLA. The Family and Medical Leave Act (FMLA) gives eligible employees the right to take up to 12 workweeks of unpaid leave during any 12-month period for certain reasons.

Cafeteria Plans (Section 125 Plans). Cafeteria Plans are tax-advantaged accounts that allow employees to pick and choose from a number of different benefits they can fund with pretax dollars.

Other Laws and Regulations

Other federal laws and regulations dealing with more specific aspects of employer health care plans include the Mental Health Parity and Addiction Equity Act (MHPAEA), the Medicare Modernization Act (MMA), and the Uniformed Services Employment and Reemployment Rights (USERRA).

Several federal laws prohibiting employment discrimination also prohibit discrimination in employee benefits, one of the most important terms and conditions of employment. Those include the Age Discrimination in Employment Act (ADEA), the Americans with Disabilities Act (ADA), Title VII of the Civil Rights Act of 1964, and the Equal Pay Act.

Same-Sex Marriages, Civil Unions, and Domestic Partner Benefits

Following the U.S. Supreme Court's decision in Obergefell v. Hodges, No. 14-556 (June 26, 2015), states are required to license same-sex marriages and to recognize same-sex marriages entered into in other jurisdictions. Laws that apply to spouses and married couples now apply equally to same-sex and opposite-sex couples who are legally married under state law.

State Laws on Benefits

States have continued to weigh in on employment and benefits issues. There’s been a steady trend for states to require that employers or insurance companies cover certain medical conditions, with coverage mandates increasing over the years.

States also have a history of regulating workers’ compensation insurance, a parallel health insurance system for work-related injuries and illnesses. Check with competent benefits counsel to learn which state regulations you may need to follow as you implement a benefits program.