Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 1
Lecture:Payors in the U.S. Health Care System
Slide content:Federal Regulation of Private Health Insurance - 1 Employee Retirement Income Security Act (ERISA) 1974 Permits and regulates self-insured health plans Does not require employer plan Requires plans to meet minimum standards Requires a grievance and appeals process Gives participants the right to sue for benefits 22
Slide notes:There are multiple Federal laws regulating both public and private health insurance. Many of the laws have been mentioned previously. One of the most important federal laws about regulation of private insurance is the Employee Retirement Income Security Act of 1974 or ERISA. It sets certain minimum standards for employer-provided health plans. It allows employers to self-insure, effectively permitting an employer to create an insurance company, bypassing state requirements. For any ERISA-organized health plan, states laws may not pre-empt Federal rules and regulations. It requires that employers provide an appeals process so employees can get benefits, and it allows employees to sue for benefits. 22