Health Insurance - Group Health Ins.

Question 1

ERISA (Employment Retirement Income Security Act)

Answer 1

In addition to
covering qualified retirement plans, ERISA regulates and protects those enrolled in group health plans.

ERISA mainly sets requirements and standards in three areas:

1.) Information disclosure—Group health plan enrollees must be given written information about the
plan in the form of a summary plan description.

2.) Accountability—A fiduciary must be named. The fiduciary administers the health plan in a
financially responsible manner and in the best interests of its enrollees.

3.) Claims procedures and appeals—Written rules are required for how claims must be filed and
how participants can appeal if they are denied covered services. Claims appeals processes must be
fair and timely.