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Health Benefits Advisor

Applicable Laws, Regulations, Publications and Related Links

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Employee Retirement Income Security Act of 1974 (ERISA) - ERISA is a Federal law that regulates employee benefit plans, such as group health plans, that private sector employers, employee organizations (such as a union), or both, offer to employees and their families.

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) - COBRA is a Federal law that provides rights to temporary continuation of group health plan coverage for certain employees, retirees and family members at group rates when coverage is lost due to certain qualifying events. Generally, COBRA applies to employers who employed 20 or more employees in the prior calendar year. If the group health plan is a multi-employer, collectively bargained plan, only one contributing employer needs to have 20 or more employees in the prior year in order for COBRA to apply to the whole plan.

The Health Insurance Portability and Accountability Act (HIPAA) - HIPAA is a Federal law that permits special enrollment when certain life or work events occur and prohibits discrimination against employees and dependents based on their health status.

Newborns' and Mothers' Health Protection Act (Newborns' Act) - The Newborns' Act is a Federal law that prohibits health plans and insurance companies (including Health Maintenance Organizations) that cover hospitalization in connection with childbirth from restricting a mothers' or newborns' benefits for such hospital stays to less than 48 hours for a vaginal delivery or 96 hours for delivery by cesarean section, unless the attending doctor or nurse midwife, or other licensed health care provider, in consultation with the mother, discharges earlier.

Mental Health Parity Act (MHPA) - MHPA is a Federal law that requires that annual or lifetime dollar limits on mental health benefits provided by a group health plan be no lower than the annual or lifetime dollar limits for medical and surgical benefits offered by that plan. MHPA applies to employers with more than 50 employees.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. For more information on MHPAEA, see the fact sheet.

Women's Health and Cancer Rights Act (WHCRA) - WHCRA is a Federal law that provides important protections for individuals who have undergone a mastectomy.

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