Compliance Assistance - Drop-In Article

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Expert Advice on Group Health Plans

Almost 60 percent of Americans are covered by health benefits plans sponsored by public and private employers.  These employers are both large and small.  The plans are a vital source of economic security for 175 million workers and their families. They are equally important to employers as one of the most valuable benefits they can offer to their employees.

Workers and employers alike can be overwhelmed when trying to understand their rights and responsibilities under the array of federal laws and regulations affecting health benefits plans.  The alphabet soup alone can be daunting, with statutes that go by such acronyms as ERISA, HIPAA, and MHPA -- even the somewhat scary COBRA! 

Without some expert advice, it can be difficult to know which laws apply to a particular group health plan, and what responsibilities employers and employees must comply with in order to be in compliance with the law.

But the task need not be daunting because there is help available from the Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor (DOL). 

EBSA oversees compliance with federal laws that govern pension and other welfare benefit plans including health plans offered by the private sector employers – including group health benefit plans.  The agency has developed a wide range of compliance assistance information, including free e-tools. 

To help unravel knotty health benefits questions, EBSA offers a special type of e-tool known as an “elaws Advisor” – an interactive program that provides workers and their families with practical guidance concerning their health coverage and helps employers understand their responsibilities under the federal laws applicable to group health plans.  The Health Benefits Advisor, at www.dol.gov/elaws/ebsa/health, provides answers to questions on:

• Employee Benefits Income Security Act (ERISA)
• Consolidated Omnibus Budget Reconciliation Act (COBRA)
• Health Insurance Portability and Accountability Act (HIPAA)
• Newborns’ and Mothers’ Health Protection Act (Newborns’ Act)
• Mental Health Parity Act (MHPA)
• Women’s Health and Cancer Rights Act (WHCRA).

The Employee Section guides workers and their families through a series of steps that help them understand their rights and responsibilities when they face various life or work events affecting their health care benefits, such as marriage, childbirth, loss of a job, or retirement.  The Employer Section of the Advisor allows private sector employers who sponsor group health plans to quickly determine which of these laws may apply to them, and then gives them the information they need to comply with the applicable laws.

Additional compliance assistance information related to health benefit plans is available on the Internet at www.dol.gov/ebsa.  Additional elaws Advisors on topics such as overtime, Family and Medical Leave, and veterans’ reemployment rights are available at www.dol.gov/elaws.