Legislative Brief: What is an ERISA Plan?

What is an ERISA Plan in the group health plan environment? ERISA has been amended many times over the years, expanding the protections available to welfare benefit plan participants and beneficiaries. ERISA violations can have serious and costly consequences for employers that sponsor welfare benefit plans, either through DOL enforcement actions and penalty assessments or through participant lawsuits.
ERISA applies to virtually all private-sector employers that maintain welfare benefit plans for their employees, regardless of the size of the employer. This includes corporations, partnerships, limited liability companies, sole proprietorships and nonprofit organizations. They exempt two types, those maintained by Governmental Employers and Church Plans.
ERISA generally applies to the following common employee benefits, regardless of whether they are insured or self funded:

  • Medical
  • Dental
  • Vision
  • RX
  • HRA’s
  • FSA’s
  • Group Life and AD&D Benefits
  • EAP’s
  • Short and Long Term Disability Benefits
  • Disease-specific Coverage (for example, cancer policies)

ALL Group health plans subject to ERISA are required to provide participants with a summary plan description (SPD). An SPD must be written in a manner calculated to be understood by the average plan participant and must be sufficiently comprehensive to inform the participant of his or her rights and obligations under the plan.

For additional information, please feel free to contact us at 214/739-5215.

FMLA Part I: Who Is Eligible?

During our many years of service to our clients, the regulation that brings the most questions is the Family Medical Leave Act (FMLA). In a concentrated effort to answer questions and bring clarity to the Act, we are going to divide the FMLA information into three distinct parts and actually give you links to appropriate forms directly from the Department of Labor website.

The FMLA allows employees to take up to 12 work weeks, consecutive or intermittent, depending on the circumstances, unpaid, job-protected leave in a 12-month period for specified family and medical reasons. Employees are eligible if they:

  • Work for a covered employer
  • Have worked for the employer for a total of 12 months
  • Have worked at least 1,250 hours over the previous 12 months
  • Work in the United States where at least 50 employees are employed by the employer within 75 miles.

There are a few exceptions related to military service. If an employee had a break in service during the 12 month employment requirement or 1,250 hour requirement due to fulfillment of the employee’s National Guard or Reserve military service obligation, the time performing the military services counts in determining whether the employee has been employed for at least 12 months or 1,250 hours. Additionally, there are military family leave entitlements, including military caregiver leave and qualifying exigency leave. Military caregiver leave allows eligible employees up to to 26 weeks (in a single 12 month period) unpaid leave to care for a service member with a serious illness or injury that is the employee’s spouse, son, daughter, parent or next of kin. To find out more details on military caregiver leave and what is classified as a “qualifying exigency,” click here to be directed to the Department of Labor website.

Our next post in the series will discuss leave entitlement.

*This article is intended to provide general guidance and should not be considered legal advice.