Telehealth

Insurance Coverage: Employee Retirement and Income Security Act (ERISA) Information

What is ERISA?

The federal Employee Retirement and Income Security Act (ERISA) was enacted in 1974. Its primary purpose was to regulate employee pension funds; however, it also restricts the ability of states to enact laws relating to employer-sponsored health insurance coverage. According to Association Health Plans, Inc. in May 2020, “Nationally, about 136 million people are covered by an ERISA-regulated health plan, making ERISA health insurance the largest segment of the U.S. health insurance market.”

There are two types of ERISA groups: fully insured and self-funded. A fully insured group purchases insurance through a commercial payer and is subject to many of the state laws governing commercial payers. A self-funded group, as the name suggests, funds its own plan and pays for employee health care and is not subject to state laws.

ERISA plans are not required to provide telehealth services in their plans, though many of them do so with variations in types of services covered, payment parity, etc.

Each ERISA is unique to the employer providing it. To determine exactly what the plan provides for telehealth services, requirements, and restrictions, contact the employer's plan administrator.

ERIC is the ERISA Industry Committee and the lobbying arm of ERISA. They have been strong advocates for telehealth both at the state and federal levels. ERIC recognizes the benefits telehealth has to offer ERISA members and has developed a Telehealth Initiative (PDF).