The term 'ERISA' is included in the Retirement edition of the Financial Dictionary. Get your copy on Amazon in Kindle, Paperback or Audio edition. Choose your edition here...
ERISA is the acronym for The Employment Retirement Income Security Act that was enacted in 1974. This ERISA legislation set up a basic level of standards for health, retirement, and various additional types of plans for welfare benefits. These include disability insurance, life insurance, and apprenticeship plans.
This Employment Retirement Income Security Act is both overseen and run by the EBSA, which turns out to be the acronym for Employee Benefits Security Administration. This EBSA operates as a division under the United States DOL, or Department of Labor. If you have any questions about the act, concerns that you are not being treated according to the law, or complaints regarding treatment as the ERISA laws relate to you, then you should contact your area ERISA office for help and clarification.
It is important to note that these protecting regulations mandated by ERISA only pertain to non government, private employers who choose to provide benefits plans and health insurance that is employer sponsored for their employees. ERISA does not force such employers to provide such these plans for employees. Rather, it only lays out regulations for the employee offered benefits that such employers make available. It is also significant that the rules and regulations set up by ERISA do not pertain to those benefits or insurance policies that are purchased by an individual privately.
ERISA does establish the requirements and standards for a number of different related elements. Reporting and accountability is required to be detailed and made available to the U.S. Federal government. The conduct for HMO’s and other managed care, as well as for other people who have financial responsibility for the administration of the plan, is strictly regulated by the ERISA rules.
ERISA also pertains to safeguards and procedures. Written policies have to be set up to determine the way that claims have to be filed, along with the claims’ appeals process in writing for any claims that are denied. ERISA further stipulates that these appeals should be decided in a reasonably timed and fair way. ERISA also proves to be a protection that insures that all plans are both offered, safeguarded, and funded in the ways that most appropriately favor the members and their best interests.
ERISA does not permit discrimination in the ways that benefits in the plan are gathered and collected for those members who are qualified. Finally, ERISA insists that a variety of disclosures be made to the participants in the plan. These include a plan summary that specifically lists out the provided benefits, the associated rules for obtaining such benefits, any limitations of the plans, and other matters including getting referrals before doctor and surgeon visits.