Health insurance regulations exist for insurers resulting from laws and regulations from various federal laws and state statutes. Many of these laws apply only to group health insurance coverage that has been provided by an employer. Various federal laws, such as COBRA and HIPAA, involve the availability, portability and continuation of heath insurance coverage. One of the main laws that covers health benefit plans in private industry is the Employee Retirement Income Security Act of 1974 or ERISA.
COBRA
COBRA is known as the Consolidated Omnibus Budget Reconciliation Act and provides for the continuation of group health insurance coverage. The law is designed to protect individuals that have lost their job from losing health insurance that was provided by an employer. COBRA provides for the continuation of health insurance coverage for up to 18 months for individuals that apply for coverage continuation. Individuals will be required to pay premiums each month for coverage.
HIPAA
The Health Insurance Portability and Accountability Act or HIPPA is a law that was passed in 1996. The law provided new rights and protections for individuals that belong to a group health plan. HIPAA prevents group health plans from including exclusions for a pre-existing condition. Discrimination towards employees and dependents based on health status is also prohibited. Individuals are also allowed to keep their health insurance coverage when switching jobs.
FLMA
The Family and Medical Leave Act of FLMA is a federal law that allows employees that are eligible to take up to 12 weeks of unpaid time off from work. The law applies to any 12-month period for certain circumstances. Circumstances can include taking time when a child has been born and the adoption of a child. Other circumstances include providing care for a family member who has a serious medical illness and recovering from a personal illness or health condition.
ERISA
ERISA is the Employee Retirement Income Security Act that was passed in 1974. The law covers benefit plans that provide welfare, retirement and health benefits. Detailed provisions are included in the law that require reporting that needs to be done to the government as well as disclosures that are made to plan participants. The law also requires that plan funds be protected and that benefits are received by eligible participants.
State Laws
Laws covering heath insurance can vary from state to state but generally provide protection that is the same or exceeds federal requirements. Many states have laws that require newborn children to automatically included on their parent’s health insurance plan for at least 31 days. Some states also require employers to have an open enrollment period each year when anyone, regardless of their health condition, can purchase health insurance.