Plans that typically fall under ERISA include:

Employer-sponsored medical, dental and vision plans
Prescription drug benefits
Group life insurance
Short- and long-term disability insurance
Health FSAs and HRAs
Accidental death and dismemberment coverage
Wellness programs that include medical services
Employee assistance programs with counseling or clinical services

If a plan is funded, sponsored, or administered by a private-sector employer and provides a benefit described in ERISA’s definition of a welfare plan, it is almost certainly covered.

Who is exempt?

Several categories of plans are not subject to ERISA. These include:

Plans offered by federal, state, or local governments
Plans sponsored by churches or religious organizations
Workers’ compensation or unemployment insurance programs mandated by state law
Voluntary plans with no employer contribution or involvement
Retiree-only health benefits not tied to ongoing employment
Certain multi-employer plans maintained outside the employer’s jurisdiction

Make sure your clients understand that offering health benefits through a private insurer doesn’t exempt them from ERISA. If they play any role in sponsoring or administering the plan, ERISA likely applies. A lot of companies think because they are fully insured with a carrier, they are exempt and that is not the case.

Why this matters now

With growing enforcement focus on fiduciary responsibilities, especially around health plans, advisors must help clients evaluate whether their current benefit programs trigger ERISA requirements.

Instant Insights /

Health plan fiduciary risks are growing: Advisors hold the key to compliance

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