Compliance

As an employer, you offer quality benefits to your employees and their families. Along the way you’ve probably found that the alphabet soup of regulations regarding employee benefit plans can be a little intimidating. There are many laws that affect employee benefit plans, below are just a few that most commonly create compliance issues that impact our clients.

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 Description (SPD).

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.

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.

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.

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 – “Janet’s Law” 1998 – Requires health plans that cover mastectomies to pay for reconstructive surgery and other services associated with a mastectomy.

This 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.