Definition
ERISA (Employee Retirement Income Security Act)
Federal law governing most employer-sponsored health plans, including their appeal requirements.
ERISA — the Employee Retirement Income Security Act of 1974 — is the federal law that governs most private employer-sponsored health and retirement plans. For health insurance purposes, the critical provisions are ERISA § 503 and its implementing regulation, 29 CFR § 2560.503-1, which establish minimum standards for claims procedures and appeal rights. If your health insurance comes through a private employer, ERISA almost certainly applies. Key rights under ERISA include the right to a full and fair review of any denied claim, the right to examine your claims file, specific insurer response deadlines, and deemed exhaustion if the plan fails to follow its own procedures.
Read more