Self-Funded Employee Benefit Plans are affected by many different Federal Regulations.  ERISA, COBRA and HIPAA are three sweeping pieces of legislation that are constantly being amended and clarified, and are often tested in federal courts.

ERISA – The Employee Retirement Income Security Act of 1974, as amended, governs Pension and Welfare Benefit Plans.  Self-funded benefit plans are governed exclusively by ERISA and not by state rules, regulations, laws or mandates.  ERISA details a sponsoring employers responsibilities including: guidelines for the handling of employee benefit funds (fiduciary responsibilities); plan documents, summary plan descriptions and plan amendments; non-discrimination guidelines; reporting requirements (5500’s) and many other aspects of employer sponsored benefit plans.  

COBRA – The Consolidated Omnibus Budget Reconciliation Act of 1985 allows insureds covered by medical plans offered by an employer with 20 or more employees to continue their coverage for either 18 to 36 months after termination, depending on the circumstances surrounding their loss of coverage.

HIPAA – The Health Insurance Protection and Accountability Act of 1996 guarantees coverage for employers with fewer than 50 employees (in fully insured plans only); allows for credit towards an employers pre-existing conditions clause…giving employees more freedom to move between jobs; and encompasses administrative simplification and medical privacy issues.

Other Legislation affecting Self-Funded Employee Benefit Plans:

• Newborn and Mothers Health Protection Act (NMHPA)
• Mental Health Parity Act (MHPA)
• Family and Medical Leave Act (FMLA)
• Age Discrimination in Employment Act (ADEA)
• Americans with Disabilities Act (ADA)
• I.R.C. Section 125 (cafeteria plans)
• I.R.C. Section 79 (affecting group life insurance)
• Regulations affecting Qualified Medical Child Support Orders (QMCSO’s)
• Uniformed Services Employment and Reemployment Rights Act (USERRA)