In Washington DC, people who have health benefits are accorded certain protections through ERISA (the Employee Retirement Income Security Act of 1974). With these protections, people who have health care coverage through a private sector plan can get their plan information and make sure that the plan managers adhere to certain standards.
ERISA Benefits Claims
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.
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.
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.
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.
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.
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.
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.