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Health Plan Administration

Why Employers Care

Employers face many challenges in sponsoring and administering their health plans for employees. While the Patient Protection and Affordable Care Act expands coverage to millions of Americans, it creates a significant administrative challenge for employers. The 2010 health care law has many provisions that don’t take effect right away and still many other provisions that must be clarified by regulations.

Employers perennially struggle with balancing the desire to make coverage as comprehensive as possible while assuring affordability for both employees and themselves. Part of the annual exercise includes examination of the drivers of cost increases, particularly unnecessary costs. Depending on their analyses, they typically make benefit changes to reduce medical costs for both the plans and employees and to keep down cost "trend". Employers that administer their plans or use third party administrators (TPAs) are constantly working to ensure that increasingly demanding compliance requirements are met so benefits teams can focus on improving employees' health.

While the Employee Retirement Income Security Act (ERISA) of 1974 generally provided a federal framework for rules governing health plans, there has been pressure both from the federal government and certain the states to change or waive ERISA.

The federal government has also expanded rules governing health plan administration which include: Family and Medical Leave Act (FMLA), Genetic Information Nondiscrimination Act (GINA), Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules, Uniformed Services Employment and Reemployment Rights Act (USERRA), and more.

What Can Employers Do?

Members of the National Business Group on Health can also voice their concerns to the Business Group's public policy team and by responding to public policy opportunities to comment on proposed regulations, contact Congress and/or the Administration, testify, or participate in related activities.

Page last updated: January 29, 2014

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