The Anatomy of ERISA Health Plans: Describing their Basic Structure and Key Areas of Variation

How do variations in ERISA health plans affect the formation of policy? The researchers examined the anatomy of key types of ERISA health plans (i.e. identifying the fundamental characteristics, features, and structures that distinguish the plans), focusing on those distinctions that are relevant to the current “patients’ rights” and “defined contribution” debates. In addition, they attempted to correct “prevalent public misconceptions” that may impede legislative development (i.e. the misconception that HMO’s are making health plan decisions, when, in fact, decisions may be made by the administrators or fiduciaries of an ERISA plan.) The researchers hypothesized that “there exist important areas of variation among different types of ERISA health plans that might present policymakers with cause to consider crafting flexible laws and regulations that take into account this variation.” The objective of the project was to provide policymakers with information on variations in ERISA health plans that are relevant to current debates on health plan regulation.