ERISA

Question 1

ERISA § 514(a)

Answer 1

Preempts any & all state
laws relating to employee benefit plans.

Question 2

514(b)(2)(A)

Answer 2

Exempts state insurance regulation from
preemption – savings clause.

Translation: If the law in question regulates INSURANCE, the law is not preempted

Question 3

514(b)(2)(B)

Answer 3

Deemer clause. Exempts some plans not deemed to be insurance plans under
ERISA, and therefore the states cannot regulate them. This inserts preemption
–> These insurance plans are SELF FUNDED plans

Question 4

Self-funded plan

Answer 4

-Employer assumes financial risk of
providing health care benefits to employees.

-Pays claims out of pocket

-Generally hire 3rd party to administer plan

-Generally have stop loss insurance to limit exposure

Question 5

Fully-funded plan

Answer 5

Employer contracts w/ ins. co. to assume risk for employees’ medical costs.

Question 6

502(a)

Answer 6

Individuals can sue under ERISA
for:

1. Benefits
2. To enforce rights under plan
3. To clarify rights to future benefits
4. Breach of fiduciary duty

-However, state law causes of action/remedies are preempted.

-Can get attorneys fees.

-If you have employer-provided insurance, you can only sue insurer under ERISA (not state law) & receive the listed remedies:

-Doesn’t matter if it is self-
funded or fully-funded
insurance