* You will be able to recognize a group health plan.
* You will be able to describe the legal framework that applies when an employer offers a group health plan to its employees.
* You will be able to identify the major federal laws regulations regulating group health plans.
* You will be able to explain why coverage can ordinarily be provided only to current and former employees and their dependents.
Gain a better understanding why group health plans are set up in certain ways and how to stay compliant with legal requirements.
When the cost of health care is paid or reimbursed by an employer, a group health plan probably exists and the employer will normally be subject to a long list of legal requirements. This topic will help you understand the types of arrangements that can constitute a group health plan and will provide an overview of the many different legal requirements that can apply to a group health plan. It will also help you understand why your group health plans are set up in the way they are and to know what questions you may need to ask to determine if your plans are in compliance with these legal requirements.
The Legal Framework for Offering a Group Health Plan
â€¢ ERISA Requirements
â€¢ Internal Revenue Code Requirements
Persons to Whom Coverage Can or Cannot Be Offered Under the Code
â€¢ Employees and Former Employees
â€¢ Self-Employed Individuals
â€¢ Other NonEmployees
â€¢ Spouses and Dependents
Laws Giving Individuals the Right to Receive Coverage
â€¢ Michelle's Law
â€¢ ACA Age 26 Mandate
â€¢ Qualified Medical Child Support Orders (QMCSOs)
â€¢ National Medical Support Notices (NMSNs)
â€¢ Children's Health Insurance Program (CHIPRA)
â€¢ Uniformed Services Employment and Reemployment Rights Act (USERRA)
â€¢ Family and Medical Leave Act (FMLA)
â€¢ Affordable Care Act (ACA)
Laws Affecting the Terms and Conditions on Which Coverage Is Offered
â€¢ HIPAA Nondiscrimination
â€¢ Age Discrimination in Employment Act (ADEA)
â€¢ Title Vii of the Civil Rights Act of 1964 / Pregnancy Discrimination Act
â€¢ Medicare Secondary Payer Paying for Coverage: Complying With Section 125 of the Internal Revenue Code
Laws Affecting Coverage for Specific Conditions
â€¢ Mental Health Parity and Addiction Equity Act (MHPAEA)
â€¢ Newborns' and Mothers' Health Protection Act (NMPHA)
â€¢ Women's Health and Cancer Rights Act (WHRCRA)
Steven P. Smith with Hinkle Law Firm LLC
ASA ,CLE (Please check the Detailed Credit Information page for states that have already been approved) ,CPE ,HR Certification Institute ,SHRM ,Additional credit may be available upon request.