Скачать или смотреть Regulation of Health Insurance Programs

Federal and state laws regulate employer and insurer practices related to health insurance, with every state having its own regulations. Key federal laws include the Health Maintenance Organization Act of 1973, the Employee Retirement Income Security Act of 1974 (ERISA), and the Americans with Disabilities Act of 1990 (ADA), along with IRS tax regulations.

The HMO Act encourages employers to offer health maintenance organizations as a benefits option, especially for companies subject to the Fair Labor Standards Act’s minimum wage rules. ERISA governs pension and welfare plans, requiring reporting, fiduciary responsibility, continuation coverage, and group health plan standards; it also includes the Women’s Health and Cancer Rights Act requiring mastectomy-related coverage. The ADA prohibits employment discrimination based on disability and requires equal health insurance coverage regardless of disability status.

The Patient Protection and Affordable Care Act (PPACA) of 2010 expands coverage by incentivizing or penalizing employers, requiring individuals to purchase insurance, eliminating lifetime coverage limits, and defining “essential benefits.” The PPACA’s individual mandate, effective in 2014, requires individuals who can afford insurance to buy it or face penalties, aiming to prevent people from delaying coverage until they are sick. The Internal Revenue Code allows tax deductions for employer contributions to health insurance premiums, with restrictions on preferential treatment for highly compensated employees, and distinguishes between self-funded and non-self-funded plants. States also regulate insurers by mandating certain benefits in policies or making them available as options, though these laws do not affect self-funded employer health plans.