A Complete Overview of Who Is Subject to ERISA

Key Takeaways

• ERISA is a federal law that regulates most private-sector retirement, health, and disability benefit plans.
• Employees covered by ERISA have rights to plan information, appeals for denied benefits, and legal remedies for fiduciary breaches.
• Government plans, church plans, and certain payroll-based benefits are not covered by ERISA and typically may not be governed by it.
• Understanding ERISA is essential when dealing with denied benefits, compliance questions, or plan disputes.

Dealing with denied employee benefits or confusing plan rules can feel overwhelming. You may be missing income you depend on, struggling with medical bills, or unsure whether your benefits are even protected by law.

ERISA, the Employee Retirement Income Security Act, sets strict rules for how private-sector benefit plans are managed. The process is complex, with technical requirements and deadlines that often make it difficult to protect your rights.

At the Law Office of Justin C. Frankel, PC, we guide clients through ERISA benefit disputes nationwide. We help cut through the confusion, challenge unfair denials, and protect the financial security you have worked hard to build.

What Is ERISA?

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most private-sector retirement and health benefit plans. Its purpose is to protect employees who rely on these benefits. ERISA requires plans to provide participants with essential information, imposes fiduciary duties on plan managers, and gives participants the right to sue for benefits or breaches of fiduciary duty. In short, ERISA holds employers accountable when offering employee benefit plans.

Key protections under ERISA include:

• Disclosure of plan details
• Fiduciary responsibility of plan managers
• Participant rights to benefits and appeals
• Federal oversight of retirement and welfare benefit plans

What Is ERISA Disability?

ERISA disability refers to employer-sponsored disability benefit plans that are regulated under ERISA. These plans provide income replacement when an employee cannot work due to illness or injury. ERISA sets strict rules for how disability claims must be filed, reviewed, and appealed. Unlike state-regulated disability policies, ERISA disability plans follow federal guidelines that are often more restrictive for employees.

Key aspects of ERISA disability include:

• Employer-sponsored short-term and long-term disability plans
• Specific filing deadlines for claims
• Required internal appeals before going to court
• Limited federal court review of denials

Because of these rules, employees often face significant challenges when appealing ERISA disability claim denials. Legal representation is especially important for navigating this process.

Who Is Covered by ERISA?

ERISA primarily applies to private-sector employers that offer employee benefit plans. This includes retirement, health insurance, disability coverage, and other welfare benefits. ERISA governs both pension and welfare benefit plans, setting federal standards that employers must follow. However, some employers and programs are excluded.

ERISA covers:

• Private-sector retirement and welfare benefit plans
• Employee pension and 401(k) plans
• Employer-sponsored health and disability plans

ERISA does not cover government employee plans, church plans, or benefits provided as simple payroll practices.

What Employers Are Covered by ERISA?

ERISA applies to most private-sector employers that provide employee benefit plans, regardless of size or industry. This includes:

• Corporations
• Partnerships
• Sole proprietorships
• Nonprofit organizations
• Unions

If a private employer offers retirement, health, or disability benefits, those plans generally must comply with ERISA.

Understanding which employers and plans fall under ERISA is important when evaluating your benefit rights. The process can be complex, and claim denials often leave employees uncertain about their options. The Law Office of Justin C. Frankel, PC, helps clients nationwide understand ERISA coverage and navigate disputes involving denied benefits.

What Employers Are Not Covered by ERISA?

Not all employers or benefit programs fall under ERISA. Exemptions include:

• Federal, state, and local government employers
• Churches and religious organizations
• State-mandated programs such as workers’ compensation, unemployment, or state disability
• Plans maintained outside the United States for nonresident aliens

These exclusions mean that employees covered by these types of benefits do not have the same federal protections provided by ERISA. If you are unsure whether your plan is covered, reviewing the plan documents or seeking legal guidance can help you understand your rights. The Law Office of Justin C. Frankel, PC works with clients to identify whether ERISA applies and to address disputes involving denied or terminated benefits.

When ERISA Coverage Is Not Clear

In some cases, it is not immediately clear whether a benefit plan falls under ERISA. Indicators that ERISA may apply include:

• The plan is established and maintained by an employer or employee organization.
• The benefits extend beyond direct wages or basic payroll practices.
• The plan has a formal structure, trust, or funding arrangement.

If there is uncertainty, reviewing your plan documents can provide answers. The Law Office of Justin C. Frankel, PC, helps clients evaluate their benefit plans and determine whether ERISA rules apply when benefits are denied or delayed.

Which Benefits Are Covered by ERISA?

If you receive retirement, health, disability, or other welfare benefits through a private-sector employer, those benefits are usually covered by ERISA. Covered benefits include plans offered by employers or employee organizations. ERISA protections include:

• Required plan disclosures
• Fiduciary accountability
• The right to sue for denied benefits

However, ERISA does not apply to government employee plans, church plans, state-mandated benefits such as workers’ compensation, or benefits paid directly from an employer’s assets without a formal plan. Understanding whether your benefits are protected by ERISA can be critical when dealing with a claim denial. The Law Office of Justin C. Frankel, PC, helps clients assess coverage and pursue their rights under ERISA when disputes arise.

Which Welfare Benefit Plans Does ERISA Cover?

ERISA applies to a wide range of employer-sponsored welfare benefit plans beyond retirement accounts. These plans are designed to support employees and their families by providing financial security and access to critical resources.

Medical, Surgical, or Hospital Care Benefits

ERISA covers most health-related employer-sponsored benefits, including:

• Major medical insurance
• Dental benefits
• Vision coverage
• Prescription drug benefits
• Health Flexible Spending Accounts (FSAs)
• Health Reimbursement Arrangements (HRAs)
• Health Maintenance Organizations (HMOs)

Disability Insurance Plans

Employer-sponsored disability insurance is covered by ERISA, including:

• Short-term disability insurance
• Long-term disability insurance

Life Insurance and Accidental Death Benefits

Employer-sponsored life insurance and accidental death and dismemberment (AD&D) plans fall under ERISA and provide financial protection for employees’ families.

Retirement Plans

ERISA plays a critical role in regulating retirement benefits. Covered plans include:

• Defined benefit pension plans
• Defined contribution plans (e.g., 401(k) plans)
• Profit-sharing plans
• Employee Stock Ownership Plans (ESOPs)

Fringe Benefit Plans

Certain fringe benefits are also subject to ERISA, such as:

• Wellness programs
• Employee Assistance Programs (EAPs)
• Apprenticeship and training programs
• Day care centers
• Scholarship funds

Other Employer-Sponsored Benefits

Some additional benefits may also be covered, including:

• Business travel accident insurance
• Housing assistance programs
• Higher education benefits

Understanding whether your benefits are categorized as ERISA welfare plans is important when reviewing coverage or appealing a denial. The Law Office of Justin C. Frankel, PC, assists clients with analyzing their plans and pursuing their rights under ERISA when benefits are withheld or disputed.

What Benefits Are Not Covered by ERISA?

Although ERISA covers many employee benefit plans, several types of benefits are excluded. Employees with these benefits may not have the same federal protections that ERISA provides.

Governmental Plans

Benefit plans provided by government entities are exempt, including those for:

• Federal employees
• State and local government workers
• Public school teachers
• Law enforcement officers

Church and Religious Organization Plans

Plans established by churches or religious organizations are generally exempt. This applies to:

• Church-affiliated hospitals
• Religious nonprofit organizations

State-Mandated Programs

Programs regulated by state law are not covered by ERISA, such as:

• Workers’ compensation
• Unemployment insurance
• State disability benefits

Certain Disability Benefits

Disability insurance provided by government programs is not covered by ERISA. Examples include:

• State-mandated short-term disability benefits
• Other benefits that fall under payroll practice exceptions

Plans Covering Sole Proprietors and Partners Only

Plans that cover only business owners or partners, with no employees, are not governed by ERISA.

Benefits Paid Directly by Employers Without a Formal Plan

ERISA does not apply to benefits offered as part of standard payroll practices, such as:

• Paid sick leave
• Vacation days provided directly through payroll

Plans Maintained Outside the United States

Plans maintained primarily for nonresident aliens working outside the United States are excluded.

Certain Voluntary or Excepted Benefits

Some voluntary benefits may also be exempt from certain regulations, but that doesn’t always mean they fall outside ERISA. For example:

• Standalone Employee Assistance Programs (EAPs) that provide medical counseling are usually covered by ERISA.
• Dental or vision plans offered separately from major medical coverage may still be ERISA plans, depending on how they’re structured.

It’s important to review the specifics of how these benefits are offered to know whether ERISA applies. The Law Office of Justin C. Frankel, PC, helps clients review plan documents and determine what legal options are available when benefits are denied or delayed.

Accounts Governed by ERISA

ERISA applies to certain types of retirement and welfare benefit accounts that are sponsored by private-sector employers. These accounts typically include:

• Defined contribution plans, such as 401(k), profit-sharing, and employee stock ownership plans (ESOPs)
• Defined benefit pension plans
• Deferred compensation plans offered by employers
• Employer-sponsored health plans, including HMOs, HRAs, and FSAs
• Employer-sponsored disability insurance
• Employer-sponsored life insurance

Accounts not governed by ERISA include:

• Individual Retirement Accounts (IRAs)
• Government employee retirement plans
• 403(b) plans tied to public schools or religious organizations
• Church plans
• Plans maintained outside the United States for nonresident aliens

Knowing whether your account is governed by ERISA is important when reviewing your rights, especially in the event of a denied claim. The Law Office of Justin C. Frankel, PC, helps clients determine which protections apply and how to respond when benefits are in dispute.

What to Do If Your ERISA Benefits Are Denied

If your claim for benefits under an ERISA plan is denied, you still have important rights. Steps to take include:

• Review the denial notice. Understand the reasons for the denial and any deadlines listed.
• File a timely appeal. Submit your appeal to the plan administrator within the required timeframe.
• Gather supporting evidence. Collect medical records, statements from your treating physician, and other documentation that supports your claim.
• Seek legal guidance. An attorney experienced in ERISA cases can help prepare a strong appeal and, if necessary, pursue the case in federal court.

Because ERISA has strict deadlines and unique procedures, many employees find the process overwhelming. The Law Office of Justin C. Frankel, PC, works with clients to prepare appeals, strengthen their claims, and challenge improper denials.

When an ERISA Plan Terminates

When an ERISA plan ends, participants still have certain protections:

• Participants become fully vested in their accrued benefits.
• Contributions to the plan stop.
• Employers must notify participants and pay any outstanding contributions.
• Plan assets must be distributed, typically within a set period.
• If a defined benefit pension plan is underfunded, the Pension Benefit Guaranty Corporation (PBGC) may step in to provide some financial protection. This doesn’t apply to 401(k)s or other defined contribution plans.

Employers are also required to complete the necessary filings to formally close the plan. For employees, understanding these protections is important to safeguard benefits during a termination. The Law Office of Justin C. Frankel, PC, assists clients in reviewing plan terminations and protecting their rights under ERISA.

Why Our Clients Trust The Law Office of Justin C. Frankel, PC

Clients turn to the Law Office of Justin C. Frankel, PC, because of our long record of results and commitment to protecting employee rights under ERISA. We have recovered more than $300 million for clients facing denied or delayed benefits.

Our firm has handled a wide range of ERISA cases, which gives us insight into the tactics insurance companies often use and how to effectively respond. We take a determined approach to pursuing claims, always with our clients’ interests at the forefront. Recognized consistently by Super Lawyers®, our attorneys have earned the trust of people who need representation when their financial security is on the line.

This track record, combined with our commitment to guiding clients through ERISA’s complex process, makes the Law Office of Justin C. Frankel, PC, a trusted choice for individuals dealing with benefit disputes.

Testimonials

“Taking on any insurance company with a claim is a daunting task for anyone. I was fearful that If I decided to file a disability claim on my own I would miss something. This would lead to a denial and the land of “lost” appeals. Having worked in the health care industry I know that the best chance to get a health insurance claim or pre-authorization approved is the very first time. Living in Virginia I was concerned about using an attorney out of state. I found Mr Frankel (Justin) via A Google search. He had almost a perfect 5 star review for very good reasons. From my first phone contact with Christina at Justin s office to the email from Justin stating that my claim was approved I was made to feel very comfortable and almost as if I was their only client. I am sure they are very busy with other clients. Despite this Justin answered phone calls and emails promptly: sometimes at 10 pm and on Saturdays! I told Justin that he is a gem in the murky legal world. This is quite refreshing. If I could give Justin and staff 6 stars I would. The retainer was a great value especially for being far from Long Island NY!!!” — Harold B.

“I would recommend the Law Office of Justin Frankel without hesitation. Atty Frankel and his senior paralegal, Christina, were amazing from beginning to end. They were consistently in touch with me and made sure I was updated and part of the disability appeal process. If you want a professional, top notch law firm fighting for your rights, I would unequivocally recommend that you call this law firm.” — Susan A.

Frequently Asked Questions

Does ERISA Apply to Small Employers?

Yes. ERISA applies to small employers if they offer employee benefit plans such as health, retirement, disability, or other welfare benefits. To confirm, you can review your summary plan or policy. Even if a company has only one employee and provides a group welfare benefit plan, ERISA requirements apply. Employers must maintain written plan documents, distribute Summary Plan Descriptions (SPDs), and provide required disclosures to participants.

Who Qualifies as a Fiduciary Under ERISA?

A fiduciary under ERISA is any person or entity that has discretionary control or authority over plan management or assets, or provides investment advice for a fee related to the plan. Fiduciaries must act prudently, solely in the interest of participants and beneficiaries, and avoid conflicts of interest.

What Is an ERISA Plan Administrator?

A plan administrator is the person or entity designated to manage the day-to-day operations of a benefit plan. Duties include maintaining plan documents and records, providing participants with information about their rights, and ensuring compliance with ERISA.

What Information Must the Plan Administrator Provide?

Plan administrators must give participants key information such as the Summary Plan Description, eligibility rules, plan features, funding status, and procedures for filing claims or appeals. They must also grant access to plan documents upon request and file required annual reports with federal agencies.

How Do I Know If My Health Plan Is Covered by ERISA?

A health plan is usually covered by ERISA if it is a private employer-sponsored group plan with formal written documents like an SPD. ERISA does not cover government employee plans, church plans, or informal payroll deduction benefits. If an employer sponsors the plan and it has a formal structure, ERISA likely applies.

Protect Your Rights Under ERISA With the Law Office of Justin C. Frankel, PC

Understanding who is covered by ERISA is essential for anyone dealing with benefit disputes. Whether you are an employee facing a denied claim or an employer working through compliance issues, knowing the rules helps protect your rights.

Because ERISA is complex, having experienced legal guidance can make a meaningful difference in how you approach your situation. The Law Office of Justin C. Frankel, PC advises clients nationwide in ERISA matters, with most of our cases coming from the New York metro area.

If you are facing an ERISA-related issue, call 888-583-4959 or use our contact form to schedule a free consultation and discuss your options.