If you've been to the doctor, you've probably read or heard of the Health Insurance Portability and Accountability Act (HIPAA). This piece of federal legislation took effect in 1996. It amended the Employee Retirement Income Security Act (ERISA) once it became law. While you may have heard of HIPAA, you might not know what rights you're entitled to under it. You need to know this, though.
The Employment Retirement Income Security Act of 1974 (ERISA) is a piece of federal legislation that oversees administrators of certain private and public industry retirement, health insurance and other welfare plans. These groups must adhere to certain standards when responding to claims and inquiries about these different plans. Any administrator that fails to adhere to these protocols and deadlines may be exposed to legal liabilities.
Workers in Washington, D.C., and across the country rely on their employee benefits, including their retirement programs, health insurance and disability insurance. This is one reason why the Employee Retirement Income Security Act, or ERISA, regulates these programs in order to protect employees from the consequences of wasteful, destructive or even fraudulent practices. In one case, popular supermarket chain Trader Joe's is facing a lawsuit over its retirement plan, specifically over the services and fees paid to an investment management company and accusations of poor choices for investment options for the plan.
Many workers in the District of Columbia have benefits plans through their employers that are covered by ERISA. When workers apply for benefits from their ERISA plans and are denied, they can appeal the denials. However, the workers must exhaust the internal appeals within the plan before they can file lawsuits.
On November 6, an attorney representing employees of IBM told the Supreme Court in Washington, D.C. that the employees should be allowed to sue the company's retirement fund managers because they did not disclose that the company's stock was overvalued. IBM's 401(k) plan invests in company stock. The Supreme Court will decide whether the Employee Retirement Income Security Act requires fund managers to disclose to employees drops in stock value that result from wrongdoing. In this case, stocks dropped because the microchip-making division had issues.
Businesses and plan administrators overseeing employee benefits in Washington, D.C., have legal responsibilities to uphold to the workers enrolled in a health, retirement or disability plan. Under the Employee Retirement Income Security Act of 1974, plan administrators must respond to participants' and beneficiaries' requests for certain documents, including basic plan descriptions and summaries of coverage. They have 30 days to respond without penalty, but they could be fined up to $110 each day afterwards.
Employees in the District of Columbia and around the country who receive benefits through their employer have a right to accurate and timely notifications about important issues affecting their health care and retirement plans. Under the Employee Retirement Income Security Act of 1974, companies must provide notices of key changes and provisions linked to their benefits. The law is designed to protect employees from damaging and wasteful choices that could undermine their much-needed benefits. One area that is included in ERISA is COBRA coverage, replacement health care coverage offered after a person loses access to workplace-provided health care for certain reasons.
One federal court decision could affect the way that health insurance benefits treat employee mental health claims in Washington, D.C., and across the country. In the case of Wit v. United Behavioral Health (UBH), a managed health care company was found responsible for denying tens of thousands of workers' insurance claims for mental health or substance abuse treatments. UBH oversees behavioral health services for a number of health insurance companies, including UnitedHealthcare.
A federal court in California has sided with plaintiffs in a class action suit concerning payment for behavioral health costs. The court ruling and rationale for the decision should make ERISA plan trustees and administrators in Washington, D.C., a little more mindful of accepted methods for treatment.
A recent ruling in the Eighth Circuit might be interesting to employees and employers in the Washington, D.C. area as well as the rest of the country. While the ruling is only binding on courts in the Eighth Circuit, it might indicate how other circuits might likewise rule.