Compliance and Regulatory Considerations in Employee Benefits

Posted on May 25, 2020 by admin
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The enactment of the Affordable Care Act (ACA) marks the latest evolution from almost no federal regulation of employer-sponsored health insurance to extensive substantive and administrative requirements. This regulation involved reporting, disclosure, and claims procedure requirements enacted in the Employee Retirement Income Security Act (ERISA). There are many potential dangers and consequences for not complying with employee benefit laws, which is why it is extremely important to collaborate with an expert in compliance-related issues.*

What You Need to Know

According to BLR, a compliance solutions company, employers need to be aware of the many coverage and benefit requirements related to healthcare insurance. There are many laws involved in these requirements, including, but not limited to:

  • The ACA
  • The Health Insurance Portability and Accountability Act (HIPAA)
  • The Consolidated Omnibus Budget Reconciliation Act (COBRA)
  • The Genetic Information Nondiscrimination Act (GINA)
  • The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
  • The Newborns’ and Mothers’ Health Protection Act (NMHPA)
  • The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
  • The Women’s Health and Cancer Rights Act of 1998 (WHCRA)
  • The Pregnancy Discrimination Act (PDA)
  • Michelle’s Law
  • Various state laws

ERISA has established the minimum standards for most voluntarily set retirements and health plans in private industries to protect individuals in these plans. For example, the plans must offer participants certain important information such as plan features and funding. In addition, it holds those who manage and control plan assets responsible for fiduciary duties, as well as establishes a grievance and appeals process for participants to get benefits from their plans. Finally, it gives participants the right to sue for benefits and breaches of fiduciary duty.

There have been many amendments made to ERISA, which broaden the protections permitted to health benefit plan participants and beneficiaries. These amendments are very important to uphold the wellbeing of so many individuals and their families. Let’s cover what a couple of these amendments do:

Consolidated Omnibus Budget Reconciliation Act (COBRA)

This amendment offers certain workers and their families the right to continue their health coverage for a limited time after certain events, such as losing a job.

The Health Insurance Portability and Accountability Act (HIPAA)

This offers crucial protection to working Americans and their families who could suffer discrimination in health coverage based on factors that relate to an individual’s health.

In general, ERISA does not cover group governmental or religious entities’ health plans or plans maintained solely to comply with applicable workers compensation, unemployment, or disability laws. The law also does not cover plans maintained outside the United States. It is in an employer’s best interest to work with a consultant who thoroughly understands these issues and can ensure their plan is compliant with federal regulations and laws.*

About Rooney Insurance Agency

Rooney Insurance Agency, established in Tulsa, Oklahoma in 1960, has provided customized business and personal insurance and employee benefits solutions to individuals and businesses in the state of Oklahoma and throughout the United States. We work to ensure that each client’s insurance coverage fits their specific needs, addresses their key risks, and protects their valuable assets. For more information on how we can help you today, contact us at (918) 582-0565.


*Rooney Insurance does not provide any legal advice to its clients. We consult with an experienced attorney for all benefit-related legal issues, and encourage our clients to do the same.