ERISA Eligibility
Austin ERISA Attorney Stephen G. Nagle Discusses How ERISA Applies To Employee Benefit Plans
If an employer decides to offer insurance as a part of its benefits package (healthcare, dental, vision, disability or any other insurance) the employer must comply with the Employee Retirement Income Security Act (ERISA). ERISA does not require employers to provide a insurance plan; rather, it regulates those plans to protect workers’ interests. If a company voluntarily offers an insurance plan, it will decide its own plan participation requirements, as long as those requirements are applied in a non-discriminatory manner. If a qualified health care plan has denied you eligibility for participation or benefits to which you are entitled, Austin ERISA attorney Stephen G. Nagle will work tirelessly to assert and protect your rights to insurance benefits.
Employers and Group Size Eligibility Subject to ERISA
Not all employers with insurance plans must comply with ERISA law. In general, private sector employers and some non-profit organizations who wish to provide health care plans with 50 or more employees must comply with ERISA law, processes and procedures. The employers whose insurance plans do not have to comply with ERISA include:
- Governmental entities;
- Churches;
- Small businesses with less than 50 employees, unless they use an insurance company for small benefit group coverage. Private sector small businesses with 20-50 employees must provide COBRA coverage under ERISA law, even if their plans would not otherwise require ERISA compliance.
ERISA also does not apply to health insurance plans you purchase on your own and not through your employer. However, in Texas, health insurance plans for government employees and independently purchased health insurance plans might have protection under applicable state insurance laws. Austin health insurance lawyer Steve Nagle has experience not only with ERISA plans but also with plans governed by Texas law.
Employee Eligibility Under ERISA Insurance Plans
If you work for a private sector company with an ERISA insurance plan, you will be eligible for benefits within the parameters set out by your employer and the plan. ERISA law does not contain any minimum age or service requirements to enroll in the plan; this is for your employer and the plan to determine. However, an employer and the insurer must offer eligibility and benefits on a non-discriminatory basis. These laws are complex, but in general, employers with ERISA insurance plans can exclude:
Employees with less than 3 years of service;
- Employees under age 25;
- Part-time and seasonal employees;
- Those covered under a collective bargaining agreement;
- Nonresident aliens with no U.S. sources of income.
If your employer has a plan subject to ERISA and you meet the eligibility requirements of the plan, the laws provide you with certain rights to care. An experienced and knowledgeable attorney can help you sort through this multi-faceted and complex federal law. If you are unsure of your eligibility or if you think you have been denied coverage or benefits in violation of ERISA, Steve Nagle will review your situation and provide answers. Contact our Austin ERISA lawyer today for a consultation to review your rights under the law.