If you receive coverage through a health insurance plan or have a retirement benefits plan, you may wonder if your plan falls within the scope of ERISA – the Employee Retirement Security Income Act of 1974. ERISA sets minimum standards for employer-sponsored health and retirement plans for private-sector employers. These standards protect plan participants and beneficiaries from arbitrary or negligent decision-making or misconduct by plan sponsors and administrators. Knowing whether ERISA’s rules cover your health or retirement plan can determine your rights and protections from adverse decisions by a plan operator or administrator.
Understand What ERISA Covers
ERISA covers most benefit plans sponsored by private-sector employers. Common examples of employer-sponsored plans subject to ERISA include:
- Retirement plans with employer contributions, such as 401(k)s and pension plans
- Health/dental/vision insurance plans
- Disability insurance plans
- Life insurance plans
Some of the primary protections offered by ERISA include mandatory disclosure requirements for plan participants and beneficiaries, a required grievance or internal appeals process to challenge plan sponsor/administrator decisions, and fiduciary duties imposed on sponsors/administrators.
Know the Exceptions
Determining whether your plan falls within ERISA’s scope will also involve knowing what kinds of plans ERISA exempts from its scope. For example, plans that ERISA does not cover include:
- Benefit plans operated by public employers (federal, state, local governments and agencies)
- Plans sponsored by religious institutions (although such institutions can opt into ERISA coverage)
- Plans required by workers’ compensation, unemployment, or disability laws
- Plans maintained outside the U.S. for non-resident aliens
Check Your Plan Documents
To confirm whether your plan qualifies as an ERISA plan, you should also review your plan documents, which may contain language designating whether the plan falls within ERISA’s scope. First, the plan documents will identify the sponsor. If your employer or its parent or affiliate sponsors the plan and you work for a private-sector employer, your plan likely falls within ERISA’s scope. Furthermore, the summary plan description and documents may contain language referencing participants’ ERISA rights and protections.
Common Signs of an ERISA-Covered Plan
Some of the standard formalities that signal whether a plan falls within ERISA’s scope include:
- The plan has a written governing document.
- The plan documents identify an administrator separate from the plan sponsor, usually a financial institution or insurance company.
- The plan has specific procedures for filing benefit claims or appealing adverse decisions on claims.
- The plan files a Form 5500 annually with the U.S. Department of Labor (which satisfies ERISA-covered plans’ annual reporting requirements)
If your plan bears most or all of these signs, your plan likely falls within ERISA’s coverage.
What to Do If You Still Cannot Tell
If you still cannot tell whether your plan falls under ERISA’s scope, other steps you can take to confirm ERISA coverage include:
- Contact the plan administrator or your HR department: Your plan documents should provide contact information for the plan administrator. Alternatively, if your employer has an HR officer or department, you can contact them to ask whether your plan has ERISA coverage.
- Contact the U.S. Department of Labor’s Employee Benefits Security Administration: The EBSA administers and enforces ERISA’s provisions and has resources to help you determine whether you have an ERISA plan.
- Contact an ERISA attorney: An ERISA lawyer can review your plan documents and advise you whether they fall within ERISA’s scope.
Contact an ERISA Attorney Today
If you participate in or receive benefits from a health or retirement plan, understanding whether ERISA covers your plan can help you determine your legal rights. Contact Unruh Law today for an initial consultation with an ERISA attorney to review the details of your plan and determine whether you have ERISA coverage.