Overview Compliance Assistance Materials Basic Information E-Tools Recordkeeping Applicable Laws and Regulations Related Topics and Links DOL Contacts Return to Benefits Menu

Frequently Asked Questions What is the Health Insurance Portability and Accountability Act of 1996 (HIPAA)? What is COBRA continuation health coverage? What are the HIPAA nondiscrimination requirements? more ...

OVERVIEW

A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or other means.

Most private sector health plans are covered by the Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (as well as other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the Act.

The U.S. Department of Labor's Employee Benefits Security Administration (EBSA) is responsible for administering and enforcing these provisions of ERISA.

COMPLIANCE ASSISTANCE MATERIALS

BASIC INFORMATION

General:

• Employment Law Guide - Employee Benefit Plans - Provides information on the Employee Retirement Income Security Act (ERISA).

• COBRA Continuation Coverage - The American Recovery and Reinvestment Act of 2009 (ARRA) provides for premium reductions and additional election opportunities for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA. The TAA Health Coverage Improvement Act of 2009, enacted as part of ARRA, also made changes with regard to COBRA continuation coverage.

• Compliance Assistance for Group Health Plans: Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Other Recent Health Care Laws - 15 key compliance considerations for group health plans with an example of a provision or practice that would not comply with the law and a tip on how to bring the plan into compliance.

• Frequently Asked Questions about HIPAA - Questions and answers about HIPAA, which amended ERISA to provide new rights and protections for participants and beneficiaries in group health plans.

• COBRA Continuation Health Coverage<div class="box-title"> Frequently Asked Questions</div> - Questions and answers that provide a general explanation of requirements under the Consolidated Omnibus Budget Reconciliation Act (COBRA) for continuation of group health coverage that might otherwise be terminated.

• 1996 Changes under HIPAA to COBRA Continuation Coverage under Group Health Plans.

• Reporting and Disclosure Guide For Employee Benefit Plans (PDF) - A quick reference tool for certain basic reporting and disclosure requirements under ERISA.

• Frequently Asked Questions on Benefit Claims Procedures and Appeals - Questions and answers that provide guidance on employee benefit plans procedures for handling health benefit claims and appeals.

• Health Laws Notice Guide - Includes a chart summarizing disclosure requirements and sample language to use.

• Self-Compliance Tool for Part 7 of ERISA: HIPAA and Other Health Care-Related Provisions - Provides a checklist to determine whether a group health plan is in compliance with the provisions of Part 7 of ERISA.

• Health Benefits Education for Small Businesses - Includes tips employers can use to help ensure that employees have the health care coverage they need.

• Multiple Employer Welfare Arrangements Under ERISA (MEWA) - Addresses many questions concerning the effect of ERISA on federal and state regulation of MEWAs. (PDF)

Participants and Beneficiaries:

• HIPAA Nondiscrimination Requirements<div class="box-title"> Frequently Asked Questions</div> - Questions and answers on health benefit regulations issued on the nondiscrimination provisions under the Health Insurance Portability and Accountability Act (HIPAA).

• Women's Health and Cancer Rights Act of 1998<div class="box-title"> Frequently Asked Questions</div> - Questions and answers about the important protections for those who elect breast reconstruction surgery in connection with a mastectomy.

• 1996 Changes in Health Care Law - Provides an overview of recent changes in federal law that can affect the health benefits of workers and their families. (PDF)

E-TOOLS

• elaws Health Benefits Advisor - Helps workers and their families better understand employer and employee organization (such as a union) provided group health benefits and the laws that govern them, especially when they experience changes in their life and work situations such as marriage, childbirth, job loss or retirement; also assists employers in understanding their responsibilities under the applicable laws.

RECORDKEEPING

• Form M-1 Online Filing System - An electronic filing system for the Form M-1 annual report for multiple employer welfare arrangements that allows filers to complete the form and submit it at no cost.

• Form M-1 Annual Report - Required to be filed for multiple employer welfare arrangements.

APPLICABLE LAWS AND REGULATIONS

• Employee Retirement Income Security Act of 1974 (ERISA) - Sets uniform minimum standards to ensure that employee benefit plans are established and maintained in a fair and financially sound manner. In addition, employers have an obligation to provide promised benefits and satisfy ERISA's requirements for managing and administering private pension and welfare plans.
• 29 CFR Parts 2509 to 2590 - EBSA (formerly known as the Pension and Welfare Benefits Administration) regulations, including interpretive bulletins related to ERISA (29 CFR Part 2509).

RELATED TOPICS AND LINKS

• Internal Revenue Service (IRS) - Provides information about the tax provisions in the Internal Revenue Code relating to health plans.

• U.S. Department of Health and Human Services' (HHS) Center for Medicare and Medicaid Services - For questions about the provisions under the Public Health Service Act.

DOL CONTACTS*

• Employee Benefits Security Administration (EBSA)
  200 Constitution Avenue, NW
  Room N-5623
  Washington, DC 20210
  Contact EBSA
  Tel: 1-866-444-EBSA (3272)
  TTY: 1-877-889-5627
  Regional Offices

• For questions on other DOL laws,
  please call DOL's Toll-Free Help Line at 1-866-4-USA-DOL. Live assistance is available in English and Spanish, Monday through Friday from 8:00 a.m. to 8:00 p.m. Eastern Time. Additional service is available in more than 140 languages through a translation service.
  Tel: 1-866-4-USA-DOL
  TTY: 1-877-889-5627

*Pursuant to the U.S. Department of Labor's Confidentiality Protocol for Compliance Assistance Inquiries, information provided by a telephone caller will be kept confidential within the bounds of the law. Compliance assistance inquiries will not trigger an inspection, audit, investigation, etc.