Legal Memorandum: Requirements for an ERISA Plan

Issue: Under Texas law, does a health insurance policy issued to a non-employee constitute an ERISA plan?

Area of Law: Employee Law, Insurance Law
Keywords: ERISA plan; Health insurance policy; Non-employee
Jurisdiction: Texas
Cited Cases: 904 F.2d 236; 859 F.2d 96; 253 Cal. Rptr. 541; 762 F. Supp. 695; 765 P. 2d 1160; 567 F.2d 692; 256 Cal. Rptr. 820; 890 F.2d 760; 688 F. Supp. 564; 471 U.S. 724; 450 U.S. 1030; 617 F.2d 1208; 481 U.S. 41; 482 U.S. 1; 492 U.S. 906
Cited Statutes: 29 U.S.C. §§1001-1461; 29 U.S.C. §1001(a); 29 U.S.C. § 1144(a); 29 U.S.C. § 1144(b) (2) (A); 15 U.S.C. § 1012(a)
Date: 02/01/2001

           The Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§1001-1461 (1988), is a comprehensive statutory scheme designed to regulate employee pension and welfare plans.  As a matter of policy, Congress has declared that it is desirable that “disclosure be made and safeguards be provided with respect to the establishment, operation, and administration of [employee benefit] plans.”  29 U.S.C. §1001(a).  An “employee welfare benefit plan” is defined as

any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, [or] death.


29 U.S.C. §1002(1).

In each case, the existence of an ERISA plan “is a question of fact, to be answered in light of all surrounding facts and circumstances from the point of view of a reasonable person.” Sayble v. Blue Cross, 256 Cal. Rptr. 820, 823 (Ct. App. 1989), review […]

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