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What is
ERISA? |
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From Consumers
For Quality Care
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ERISA is
a 1974 federal law - the Employee Retirement Income and Security Act.
An unintended loophole of ERISA prevents patients with employer-paid
health care from obtaining damages against HMOs that deny them medically
necessary treatment. Currently, no matter how outrageous the
corporate conduct, or serious the consequence of the treatment denial,
patients who receive their health care through their employers cannot
hold their HMO accountable.
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Is Your Insurance Plan an ERISA
Plan? |
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by Harvey Frey, MD, PhD, JD
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ERISA does not govern if:
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1.
Your insurance is unconnected with your employment, or
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2.
The covered person is
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i.
self-employed (29 CFR 2510.3-3(b)), or
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ii.
is a partner in a professional partnership (29 CFR
2510.3-3(c)), or
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iii.is a partner in a professional partnership (29 CFR
2510.3-3(c)), or
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3. The insurance IS connected with your employment, but your
employer
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i.
Is an agency of any level of government, or
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ii.
Is a religious organization (29 USC 1002(l)), or
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iii. Is minimally involved, i.e.: The employer makes no
contributions toward the premiums, Participation is
completely voluntary for the employees, employer doesn't
"endorse" the program, the employer does no more
than allow the insurer to publicize it to the employees,
collect premiums through the payroll deduction, and remit them
to the insurer; and the employer gets no compensation except
for its administrative services. (29 CFR 2501.3-1(j))
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