Employee welfare benefit plans, as defined under the Employee Retirement Income Security Act of 1974 (ERISA), are subject to ERISA's general compliance obligations (which include disclosure requirements, reporting rules, and fiduciary standards of conduct). ERISA generally defines an employee welfare benefit plan as a plan, fund, or program established or maintained by an employer to provide specified benefits (including medical benefits) to participants or beneficiaries, through the purchase of insurance or otherwise (29 U.S.C. § 1002(1)).

Additional ERISA compliance obligations apply to a subset of employee welfare benefit plans known as group health plans. For example, group health plans must meet expanded requirements under the Department of Labor's claims procedure regulations (29 C.F.R. § 2560.503-1). ERISA defines a "group health plan" as an employee welfare benefit plan that provides medical care to employees or their dependents (directly or through insurance, reimbursement, or otherwise). Medical care includes amounts paid:

The Internal Revenue Code (Code) and the Public Health Service Act (PHSA) include their own definitions of (and requirements for) group health plans (ERISA § 733(a) (29 U.S.C. § 1191b(a)); 26 U.S.C. §§ 9832(a) and 5000(b)(1); PHSA § 2791 (42 U.S.C. § 300gg-91)). Plan sponsors must self-report many group health plan compliance failures to the Internal Revenue Service using IRS Form 8928 (see Practice Note, Excise Tax Reporting for Group Health Plans (IRS Form 8928)).

Many of the group health plan mandates—including those added under the Affordable Care Act (ACA) and more recent legislation—also apply to health insurers that offer coverage relating to group health plans (in addition to health insurers offering individual market coverage). Under ERISA, the Code, and the PHSA, health insurers are defined to include insurance companies and other organizations (for example, health maintenance organizations (HMOs)) that are:

This toolkit is a collection of resources addressing requirements for group health plans and health insurers under ERISA, the Code, and the PHSA. These statutes have been amended over the years to include additional mandates—for example, the mental health parity rules. Additional mandates for group health plans and health insurers were added during 2020 as a result of statutory and regulatory developments that included:

For resources addressing the ACA, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), COVID-19, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), health reimbursement arrangements (HRAs), the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), ACA contraceptives, and the Supreme Court's 2022 decision overruling Roe v. Wade, which had recognized a federal constitutional right to abortion (Dobbs v. Jackson Women's Health Org., 142 S. Ct. 2228 (2022)), see respectively:

The following resources address group health plan compliance requirements under the CAA-21:

For a collection of resources addressing the surprise medical billing requirements for group health plans, health insurers, and health providers under the No Surprises Act (NSA), which was enacted as part of the CAA-21, see Surprise Medical Billing for Health Plans, Health Insurers, and Health Care Providers and Facilities Toolkit.