This federal law allows employers to maintain the uniformity in the structure, administration, and regulation of benefits across the country in different states when employees are present in different states. The enactment of ERISA allowed Congress to displaced state law in regards to employees benefit plans and so it allows employers to operate benefit plans across the nation regardless of state benefits laws. It also provides consistency in remedying for employees to challenge the denial of pensions, health insurance or in getting other benefits. One of the benefits to ERISA participants is that they have rights to sue the plan in federal court to get the benefits they are entitled to according to the plan. They are entitled to recover the full amount of healthcare benefits that is payable as per of the plan, but they are not entitled to get any more than that amount. The federal ERISA known to cause two main issues that is applied to manage care in the concept of the healthcare benefits. The first issue is the ERISA plan has little or no financial incentives to authorize or pay for care. There are many patients who won’t challenge denials on their benefits and whoever choose to challenge, they ultimately lose. The second issue is the ERISA has produced discrepancy in the cases of denial of care. According to the balanced legal system, similar cases are subjected to treat in a similar way and the legal rights of individuals should be independent of the unexpected conditions. While in ERISA, similar cases end up with different solution and results and the
results or outcomes are dependent on the areas from where the patients have obtained their health insurance coverage (Harris, 2007). Reference: Harris, D.M. (2007). Contemporary issues in healthcare law and ethics (3 rd ed.). Chicago, IL: Health Administration Press. MONDAY Discussion questions 1.Question: 1 What legal risks are present when entering into and working under a health care contract? How would you ensure that a health care contract meets all legal requirements to be valid? How can you avoid ethical issues in meeting contract requirements?
- Fall '14
- healthcare providers