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The Current State of ERISA

The Employee Retirement Income Security Act (ERISA) has developed since it first passed in 1974. Some of the most pressing and evolving issues today pertain to marriage statuses under ERISA, the impact of the Affordable Care Act, if any, on ERISA and the several ongoing litigations pertaining to the intricacies of when it applies and relief is granted and when it does not.

Supreme Court and ERISA

As with most Congressional acts, the application of ERISA has been formed and crafted through multiple US Supreme Court cases. A sampling of recent rulings reveal the complicated nature of the law, as well as the developing way it is applied. In the upcoming term, the Court will hear arguments pertaining to the deadline for filing a complaint to challenge a denial of disability under ERISA. In April 2013, the Court ruled that ERISA does not authorize the overturn of the terms of a contract in a health benefit plan through the application of equitable principles.

In May 2011, the Court ruled on what "showing" is required to entitle participants in the pension plan to recover benefits where there has been an alleged inconsistency between the explanation of benefits and the terms of the plan. The Court found that the district court was not authorized to grant relief under ERISA's recovery-of-benefits-due provision but that a different provision authorized similar relief, remanding the case to the district court for reconsideration.

In May 2010, the Court found that the wording of ERISA did not require an individual to be a "prevailing party" to be eligible for attorney's fees. That same month, the Court ruled that a district court has an obligation to defer to an ERISA plan administrator's reasonable interpretation outside the context of an administrative claim for benefits.

Marriage and ERISA

The legalization of same-sex marriage in various jurisdictions around the country has had little impact on ERISA due to the Defense of Marriage Act [PDF] (DOMA). For all federal laws and regulations, DOMA defined the term "marriage" as being between a man and a woman and "spouse" as being limited to a person of the opposite sex. In June 2013, the Supreme Court ruled DOMA unconstitutional, thus reinstating the individual state definitions of marriage for federal law purposes.

On September 19, the US Department of Labor issued guidance that the terms "spouse" and "marriage" should now be interpreted as including all legally married same-sex relationships. This means that same-sex spouses should be offered retirement benefits under ERISA, even if they are married in a state where same-sex marriage is illegal, so long as the spouses were legally married in another state. There are still intricacies of what this means in regards to states where same-sex marriage is still illegal, given the untested nature of this in the courts.

The federal government has also issued [PDF] a statement that all same sex spouses of federal employees are eligible for retirement benefits, although this falls outside of ERISA since it only applies to the private sector.

The Patient Protection Affordable Care Act and ERISA

The Affordable Care Act created ยง 715 of ERISA. It reads, in part:

(a) Except as provided in subsection (b):
(1) the provisions of part A of title XXVII of the Public Health Service Act (as amended by the
Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subpart; and
(2) to the extent that any provision of this part conflicts with a provision of such part A with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such part A shall apply.

The impact this will have on ERISA is not totally known due to it not being fully enacted yet, although its goal is to ensure and protect continued healthcare coverage to individuals who are promised some sort of continued welfare benefit post-retirement.




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