ERISA Section 607 defines the term group health plan as an employee welfare benefit plan providing “medical care” to participants or beneficiaries 1) directly, 2) through insurance, 3) reimbursement, 4) or otherwise. ERISA Section 607 refers to Section 213(d) of title 26 to generally define the term medical care as amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.
Employers need to take a close look at all their benefit programs to determine if a group health plan exists under the ERISA law. When a group health plan exists certain compliance obligations may apply, such as providing participants a Summary Plan Description (SPD), offering the program to COBRA beneficiaries, and reporting information about the program under Form 5500.
The programs listed below generally fall into the category of a group health plan: