Laws That Help You Maintain Insurance – ERISA

Your particular situation is defined by whether you have an individual or group plan, the state in which you live, and federal law. However, there are federal and state protections that allow you to maintain your access to health insurance.

The Employee Retirement Income Security Act (ERISA) is administered by US Department of Labor and provides protection for individuals enrolled in benefit plans sponsored by private-sector employers (the law does not apply to federal, state, local, or church health plans).

ERISA also sets specific time periods for when you must be notified about any claim decision. If your claim is denied, you must provide a detailed explanation why your claim was denied and a description of the appeal process. In addition, the plan must include the rules, guidelines, or exclusions used in the decision or provide you with instructions how you can request a copy from the plan.

If you have an insurance issue which falls under the guidelines for HIPAA or COBRA, you need to seek help from the Department of Labor, instead of a state health insurance agency.

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