Insurance Regulation Flashcards
Administrative Record
(ERISA)
Generally, the administrative record includesany available documents that are available to be reviewed such as plan plus any information in the claim file.
Age Discrimination in Employment Act (A.D.E.A.)
This Federal Law prohibits discrimination on the basis of age in such matters as hiring, job retention, compensation, and other terms, conditions, and privileges of employment. Compliance with the law is the responsibility of the employer.
Americans with Disabilities Act (A.D.A.)
This federal law prohibits discrimination on the basis of a disability for hiring, compensation, benefits, etc. and requires employers make accommodations as necessary for employees with disabilities. Compliance is the responsibility of the employer.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
A health insurance program that allows an eligible employee and their dependents to maintain health insurance coverage if they lose their job or otherwise become ineligible.
Employee Retirement Income Security Act
(ERISA)
A federal law that sets minimum standards for most voluntarily established benefit plans in private industry.
Family and Medical Leave Act (FMLA)
A 1993 labor law requiring covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons.
Health Insurance Portability & Accounting Act (HIPAA)
A 1996 law that provides data privacy and security provisions for safeguarding medical and private, personal information (PPI).
Office of Foreign Assets Control (OFAC)
A department of the federal Treasury that administers and enforces economic and trade sanctions based on US foreign policy and national security goals. This body is charged with enforcing the Patriot Act.
Social Security Disability (SSD or SSDI)
Social Security Disability Benefits/ Social Security Disability Income Benefits (SSD or SSDI) (SSD or SSDI) means benefits that the Person themself is entitled to receive as a result of their eligibility for benefits through the Federal Social Security Administration. This is also known as Primary Social Security Benefits.
Family Social Security Benefits means benefits that a Person spouse or Child(ren) are entitled to receive, as a result of, the Person’s eligibility for disability insurance benefits through the Federal Social Security Administration.
Supplemental Security Income (SSI)
A federal program that provides monthly payments to adults and children who have low income and resources, and who are blind or disabled.
Social Security Retirement
A federal program that provides replacement income for qualified retirees.
Summary Plan Description (SPD)
A document that employers are required to provide to employees or plan participants explaining how the plan operates – the plan’s benefits, the claim review procedures, and the participant’s ERISA rights – in a way that is easily understood.
