Introduction to Health Insurance

Health insurance is probably the most important benefit that employers provide to their employees. For workers, employer-provided health coverage gives them some security about their own and their family’s health in a way that is typically more affordable than individual insurance. For employers, offering health coverage is often a necessary compensation form to remain competitive in the marketplace.

The landscape of employer-provided health insurance is impacted by laws at the federal and state level, as well as the marketplace for insurance plans. The Health Insurance section covers:

• Form 5500 Series;
• Types of insurance plans;
• Dental coverage;
• Vision coverage; and
• Multiple Employer Health Plans.

The following are major federal laws that impact employer-sponsored group health plans:

• CHIPRA
• COBRA
• ERISA  
• FMLA  
• GINA
• HIPAA
• Mental Health Parity Act
• Mental Health Parity and Addiction Equity Act
• Michelle’s Law
• Newborns’ and Mothers’ Health Protection Act
• Patient Protection and Affordable Care Act
• USERRA
• Women’s Health and Cancer Rights Act

Special Note: DOL Releases Affordable Care Act Study on Self-Insured Employee Health Benefit Plans

The U.S. Department of Labor (DOL) has released its first annual report on self-insured employee health benefit plans. The report, which is required by the Affordable Care Act, contains general information on self-insured employee health benefit plans and financial information on the employers that sponsor them.

Self-insured plans, unlike fully insured plans, are generally plans in which the sponsor retains the risk associated with paying covered health expenses, rather than paying a premium and transferring the risk to an insurance company. Some sponsors retain the risk for a subset of the benefits, but transfer the risk for the remaining benefits to health insurers – that is, they finance the plans' benefits using a mixture of self-insurance and insurance. Self-insurance is more common among larger sponsors, mainly because the health expenses of larger groups are more predictable and therefore larger sponsors face less risk.

The report includes information on self-insured and mixed health benefit plans that are required to file a Form 5500 Annual Return/Report of Employee Benefit Plan. Health benefit plans covering private-sector employees must file a Form 5500 if they cover 100 or more participants or hold assets in trust. This report presents data on such plans for 2008, the latest year for which complete data are available.

Additional Information

The U.S. Department of Labor’s Consumer Information on Health Plans is a central location to view a variety of resources dedicated to consumers and health benefits, including overviews of the major federal health insurance-related laws, publications and guides, and links to related health care websites.

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