The following is a list of some common compliance areas that impact our clients on a regular basis.
Please note that there are many laws that affect employee benefits plans and these are not
the only laws you need to be informed about. This list is intended to be a quick overview
of a number of basic reporting and disclosure requirements that group health plans and/or
employers must provide to participants, beneficiaries and other individuals under Title I
of ERISA and other miscellaneous federal laws.
-
COBRA – Consolidated Omnibus Budget
Reconciliation Act of 1985 – Allows certain former employees, retirees, spouses, and
dependent children the right to continue health coverage for a limited amount of time.
-
ERISA – Employee Retirement Income
Security Act of 1974 – Laws regulating the establishment and administration of employee
health and welfare plans. Also imposes reporting and disclosure requirements, including
Summary Plan Descriptions.
-
HIPAA – Health Insurance Portability
and Accountability Act of 1996 – Limits a group health plan's ability to impose pre-existing
condition exclusions, provides special enrollment rights for eligible persons; prohibits
group plans from individual discrimination based on health conditions. Creates national
standards for handling individuals' protected health information.
-
FMLA – Family and Medical Leave Act of
1993 - Provides eligible employees with up to 12 work weeks of unpaid leave a year for certain
medical or family reasons. Requires group health benefits to be maintained during the leave.
-
Medicare Part D – Plans that offer
prescription drug coverage on a group basis to active and retired employees and to Medicare
Part D eligible individuals must provide a notice of creditable or non-creditable prescription
drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for,
prescription drug coverage under the entity’s plan. This creditable coverage notice alerts
the individuals as to whether or not their prescription drug coverage is at least as good as
the Medicare Part D coverage.
-
MHPA– Mental Health Parity Act of
1996 – Provides parity of annual and lifetime dollar limits on mental health benefits with
those of medical/surgical benefits.
-
MSP Laws – Medicare Secondary Payer –
Laws that govern which coverage pays first when a Medicare beneficiary also has coverage
through a group health plan. Rules are based on the number of employees, the reason for
Medicare eligibility and the work status of the health plan enrollee.
-
Newborns’ and Mothers’ Health Protection Act –
The plan’s SPD must include a statement describing any requirements under federal or state law
applicable to the plan, and any health insurance coverage offered under the plan, relating to
any hospital length of stay in connection with childbirth for a mother or newborn child. If
the federal law applies in some areas in which the plan operates and state law applies in
other areas, the SPD should describe the different areas and the federal or state requirements
applicable in each.
-
Qualified Medical Child Support Orders – This
is a notification from the plan administrator regarding receipt and qualification determination
on a medical child support order directing the plan to provide health insurance coverage to a
participant’s noncustodial children.
-
USERRA – Uniformed Services Employment and
Reemployment Rights Act of 1994. – Protects the employment rights and benefits of those who serve
our country voluntarily or involuntarily in the armed forces.
-
WHCRA – Women's Health and Cancer Rights
Act 1998 – Also know as "Janet's Law" – Requires health plans that cover mastectomies to pay for
reconstructive surgery and other services associated with a mastectomy.
Please note that the information presented on this page is intended to provide general
information on common compliance issues. Every effort has been made to ensure the accuracy
of the information; however, the law and regulations may change over time. The information
presented on this website does not constitute legal advice. You should consult an attorney
or other professional with specific questions regarding your compliance obligations.