A group health plan is an employee welfare benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.
Most private sector health plans are covered by the Employee Retirement Income Security Act (ERISA). Among other things, ERISA provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. Also, those individuals who manage plans (and other fiduciaries) must meet certain standards of conduct under the fiduciary responsibilities specified in the law.
The Department of Labor’s Employee Benefits Security Administration (EBSA) is responsible for administering and enforcing these provisions of ERISA. Click on the agency to find out more about the agency’s program. As part of carrying out its responsibilities, the agency provides consumer information on health plans as well as compliance assistance for employers, plan service providers, and others to help them comply with ERISA.
The Fair Labor Standards Act (FLSA) does not address benefits such as life insurance, long-term care insurance, medical insurance accounts or wellness benefits. These benefits are generally a matter of agreement between an employer and an employee (or the employee’s representative).
For questions about the tax provisions in the Internal Revenue Code relating to health plans, please contact the Internal Revenue Service.
For questions about the provisions under the Public Health Service Act, contact the Center for Medicare and Medicaid Services in the Department of Health and Human Services (HHS).
Employee Benefits in the United States (PDF 3.5Mb) This Bureau of Labor Statistics (BLS) bulletin shows access and participation in and key provisions of employee benefit plans for workers in private industry and state and local governments.