Legislation and Compliance

The following summaries address federal mandates and their applicability to plan sponsors of self-funded benefit plans. This information is only introductory and a summary and should not be relied upon as legal advice. You should contact your legal counsel rather than relying on this information.

Overview of Health and Welfare Plan Regulations
In 1945, passage of the McCarron-Ferguson Act by the federal government delegated regulations of the insurance industry to the states. There are certain exceptions, but generally, regulation of the insurance industry remains with the states today.

However, the McCarron-Ferguson Act did not delegate regulation of self-funded plans to the states. Regulation of self-funded plans rests almost exclusively with the federal government.

ERISA and Self-Funded Plans
ERISA was enacted by Congress in 1974 to protect interstate commerce and the interests of employee benefit plan participants and beneficiaries of financial and other information, by establishing standards of conduct, responsibility, establishing standards for fiduciaries of employee plans, and by providing for appropriate remedies, sanctions and ready access to the federal courts.

ERISA requirements apply to all health and welfare benefit plans, except government and church plans, regardless of funding mechanism.

Americans with Disabilities Act (ADA)
Age Discrimination in Employment Act (ADEA)
Balanced Budget Act
Cafeteria Plans
Claims Procedure
Continuation of Coverage (COBRA)
Employee Retirement Income and Security Act (ERISA)
Family and Medical Leave Act of 1993
Health Care Fraud and Abuse Data Collection Program
Health Insurance Portability And Accountability Act Of 1996 (HIPAA)
Medicare
Mental Health Parity Act
Mental Health Parity Act - Extension (posted 3/6/02)
Newborns’ and Mothers’ Health Protection Act of 1996
Non-Discrimination Rules
Omnibus Budget Reconciliation Act of 1993
Pregnancy Discrimination Act
State Legislation:
    Massachusetts Uncompensated Care Pool Surcharge
    New York Health Care Reform Act of 1996/Health Care Reform Act of 2000
Section 125
Standards For Electronic Transactions
Standards For Electronic Transactions - Implementation Delayed (posted 3/6/02)
Summary Plan Description
Summary Plan Description - PWBA Issues Final Regulations (posted 3/6/02)
Uniform Services Employment and Re-employment Rights Act of 1994
Women’s Health and Cancer Rights Act (WHCRA)
Additional Resources