Study of laws protecting consumers from loss of health benefits

This project will review consumer protection laws and practices covering different types of health insurance plans. The project will construct a matrix of plan arrangements, show how state and federal laws protecting consumers apply to each of those arrangements, and estimate how many Americans are protected to what degree in each plan type. The study will encompass both insured and self-insured plans. It will provide a legal analysis of the interaction of federal employee benefit law (ERISA) and state insurance and managed care statutes generally, while zeroing in on a sample of three states to provide a more detailed account of the level of consumer protection resulting from the combined effects of federal and state statutes. The goals and scope of the study are: (1) Identify key categories of consumer protections covering people in private-sector employee benefit plans. Possible categories for study include: plan solvency standards, mandated benefit requirements or lack thereof, legal remedies for consumers' grievances, disclosure requirements, etc. (2) Analyze how the interaction of ERISA, state insurance statutes, and other laws, including those concerning managed care entities, affect individuals in terms of benefit safeguards. (3) Identify new types of provider/insurer arrangements that may fall in "gray areas" where the ambit of regulatory authority is not clear. (4) Provide a rough estimate of how many Americans fall in each category created by combinations of federal and state laws. (5) Identify policy implications of differing levels of consumer protection. (6) Identify areas for further research, including the regulatory issues raised by the emergence of new forms of provider/insurer entities. The results of this project will be important for identifying gaps in consumer protection laws for health insurance as well as for identifying issues that will need to be dealt with should the Medicare program be opened up to new types of plans.

Grant Details

Amount Awarded $55,470.00

Awarded on: 11/15/1995

Time frame: 12/1/1995 - 7/31/1996

Grant Number: 27193


George Washington University

2121 Eye Street, N.W.
Washington, 20052-1001


Judith Miller Jones
Project Director


Karl Polzer
Project Director