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 Affordable Care Act (ACA) bars preexisting condition restrictions, requires coverage of dependents to age 26, bars cost sharing for preventive care, encourages wellness programs, 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.