Our ERISA attorney says that anyone who receives a pension should understand recent changes to the Employee Retirement Income Security Act (ERISA). Although the legislation was enacted in 1974, amendments to the program over the past few years have changed many aspects of the law.
What Is ERISA?
The first question many people ask is “What is ERISA?” ERISA is a federal law that sets minimum standards for pension and health plans that are established voluntarily in private industry in order to protect those who enroll in the plans. As with any law, there is a need for Congress to make adjustments and changes in order to address changing policies in the industry, or to repair any loopholes that exist that could lead a participant to suffer damages when a plan is not administered properly.
Addition of COBRA
In 1985, Congress added the Consolidated Omnibus Budget Reconciliation Act (COBRA), to provide health coverage after termination from a position. In order to qualify for COBRA, the former employee must have participated in healthcare coverage offered by the company before they were terminated and must have been a qualifying event that caused the employee or the employee’s spouse to lose their coverage. This could be divorce or termination. COBRA coverage payments are the responsibility of the employee and begins on the first day the termination takes effect. Coverage lasts for 18 months for the employee and up to 36 months for spouses and children.
HIPAA Legislation
Another amendment to ERISA, according to an ERISA attorney, is one many people are not aware are part of that legislation. The Health Insurance Portability and Accountability ACT (HIPAA) was created to make healthcare more secure and many people are aware of the act due to new privacy policies established for healthcare providers related to who could be informed of any health problem a patient was suffering. However, the legislation also addresses preexisting medical conditions. Prior to the passage of HIPAA, a health plan could exclude coverage if an applicant had a preexisting condition that was treated up to 12 months before enrollment. After the passage of the legislation, only medical conditions treated up to six months before enrollment may be considered. In addition, the law requires employers give credit to employees for time they held health insurance previously.
Protections for Mothers and Newborns
The Newborns’ and Mothers Health Protection Act, commonly known as the Newborns’ Act, was established in 1996 in order to protect the health of newborns and their mother after childbirth. It requires health insurance providers to pay for at least a 48-hour hospital stay following a vaginal childbirth and up to 96 hours for a cesarean section. A doctor may determine that mother and baby can be released sooner, but the plan administrator cannot make that determination. Some states have longer terms that the insurance company must pay for and, if this is the case, the state law takes precedence over the federal law.
Treatment of Mental Illness
In 2008, Congress enacted the Mental Health Parity and Addiction Equity Act (MHPAEA) to guarantee treatment for mental illness on an equal basis as other medical conditions. This means that coverage of mental illness must be as comprehensive as treatment of other illnesses in every insurance plan. This provision only affects employers with more than 50 employees. It does not require that employer-funded plans cover mental illness, but if the plan does, the coverage must be equal to the coverage of other illnesses.
Breast Reconstruction
In 1998, Congress added an amendment to ERISA requiring plans that cover mastectomy must also cover the cost of breast reconstruction as well. Deductibles and coinsurance may be applied for the procedure, but the plan must allow a woman who has undergone a mastectomy to be covered for follow-up reconstructive surgery as well. At least half of the women who undergo mastectomy elect to have breast reconstructive surgery. Many of the women choose reconstruction in an effort to have a more “normal” body appearance. The amendment was added to allow any woman who wanted to undergo breast reconstruction to have the procedure covered by their health insurance.
Contact an ERISA Attorney
If you have an employer-funded retirement or healthcare plan, you may have heard of this legislation and asked “What is ERISA?” If your employer’s plan has violated any of the requirements under ERISA, including the amendments, you need to discuss your rights with an ERISA attorney. Contact Jonathan M. Feigenbaum, Esquire today to learn what rights you may have under ERISA. Contact us online or by phone at 1-866-396-9722 to arrange your consultation related to any ERISA violations you may have suffered.
