How Does ERISA Affect Health Insurance Plans in Pennsylvania?

Anyone familiar with ERISA might know that this complex federal law applies to certain employee retirement accounts maintained by employers. Many might not know that ERISA also applies to health insurance plans maintained by employers. While health insurance and retirement plans are not the same, they both represent accounts and funds maintained by employers for the benefit of employees. So, how does ERISA apply to health insurance in Pennsylvania, anyway?

Under ERISA, employers owe a fiduciary duty to employees and must maintain health insurance plans for their benefit. Employees may have the right to take legal action if a health insurance plan is somehow mismanaged. Before you act, talk to a lawyer about whether ERISA even covers your plan. Some plans, such as those maintained by the government or churches, are not covered by ERISA. On top of it all, health insurance plans covered by ERISA may also be covered by COBRA, which allows people who lose their health benefits to extend them under certain circumstances.

For help with an ERISA claim, contact our Pennsylvania disability attorneys for a free case review by calling Young, Marr, Mallis & Associates at (215) 515-2954.

How ERISA Applies to Pennsylvania Health Insurance Plans

The Employee Retirement Income Security Act (ERISA) is a federal law regulating how employers manage retirement accounts, disability benefits, health insurance plans, and other accounts or benefits for employees. Many Pennsylvania workers rely on the health insurance they get through their jobs to be able to afford any health care at all. Workers who might have disabilities or people who rely on disability benefits are especially vulnerable.

ERISA creates a fiduciary duty in employers. A fiduciary duty requires the fiduciary (i.e., the person in charge of the accounts) to maintain those accounts for the benefit of others. As a fiduciary, your employer must put the needs of employees before their own when it comes to health insurance plans and other benefits. For example, employers who offer health insurance plans to employees must make sure that all employees can benefit, including those with disabilities whose healthcare costs might be greater.

ERISA also gives employees legal recourse if employers violate ERISA rules and regulations. There may be an appeals and grievance process employees can follow to hopefully rectify the situation. Maybe your health insurance plan was altered without any notice, and now you cannot afford medical care for your disability. In such a case, our West Chester, PA disability lawyers will help you bring the issue to your employer’s attention and get it fixed.

What Kind of Health Insurance Plans ERISA Covers in Pennsylvania

Before taking your claims to court, speak to an attorney about whether your health insurance plan is even covered. While many workers throughout Pennsylvania rely on health insurance, not all plans are the same, and some are not governed by ERISA. However, even if ERISA does not cover your health insurance, that does not mean that your employer may do whatever they want regarding the management of the plan. If you believe your health insurance has been put in jeopardy, speak to our team about it.

While many, if not most, health insurance plans fall under ERISA, certain employers are outside this federal law. First, and perhaps most surprisingly, government employers are not covered by ERISA. If you work for a government agency or entity, your health insurance might not fall under ERISA. Common examples of government employees include police officers, public school teachers, state-level administrators, and many others.

If you work for a church or another religious group or organization and have health insurance through work, your health insurance plan is also not covered by ERISA. This can be tricky to figure out, as churches and religious groups tend to employ a mix of employees and volunteers. If you are a volunteer, you likely are not eligible for health insurance through the church. However, if you are an employee, your health insurance is not covered by ERISA.

Health insurance plans maintained solely to comply with Workers’ Compensation, disability, or unemployment laws are also not covered.

How ERISA and COBRA Affect Pennsylvania Health Insurance Plans

A fear of many employees is losing their health insurance if they get laid off or choose to switch jobs. Many people stay in jobs they do not like so that they can keep their health insurance. If you find yourself in a position where you lose your health benefits, ERISA might help you.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed in 1986 and amended ERISA to require certain employers to provide a temporary continuation of group health benefits to employees under certain circumstances. In short, under COBRA, you might be able to keep your health benefits for a little while, perhaps until you are able to find a new job with health insurance.

COBRA may only help extend group health plan coverage in light of a “qualifying event.” Such an event might be a reduction in an employee’s hours that might make them no longer eligible for benefits or the termination of the employee from their job. How long COBRA lasts depends on the nature of the qualifying event. For example, if you lose your health coverage because you are terminated, COBRA may extend your benefits for 18 months. Family members of employees who have lost jobs might also benefit from extensions of health benefits under COBRA.

Pennsylvania has a law called “mini-COBRA” that applies to small business employees in the state. Under mini-COBRA, employees of a small business, defined as having 2-19 employees, have the right to purchase a continuation of health insurance after leaving employment. An eligible employee may purchase health insurance through their former employer for up to 9 months after their employment ends.

Contact Our Pennsylvania Disability Lawyers for Assistance with Your Claims

For help with an ERISA claim, contact our Philadelphia disability attorneys for a free case review by calling Young, Marr, Mallis & Associates at (215) 515-2954.