ERISA Plan
An ERISA plan is an employer-sponsored health plan governed by federal ERISA law rather than state insurance rules — which changes the appeal rights, deadlines, and leverage on a denial.
An ERISA plan is a health plan an employer sponsors for its employees, governed by the federal Employee Retirement Income Security Act rather than by state insurance law. This matters on a denial because ERISA sets its own claims-and-appeals framework: specific timeframes for the payer to respond, a right to a 'full and fair review,' and a right to request the plan documents and the basis for the denial. Most self-funded employer plans are ERISA plans, and ERISA generally preempts state law — so state prompt-pay statutes and some state appeal remedies don't apply the way they would to a fully-insured plan. That cuts both ways: you lose some state-law levers, but you gain federal ones, including the right to demand the plan's actual governing documents and the specific reason for the adverse decision, which can expose a denial that doesn't match the plan's own terms. Knowing whether a denial is on an ERISA plan changes the appeal strategy — the deadlines, the documents you're entitled to, and the arguments available are federal, not state. It's often not obvious from the remit alone which plans are ERISA-governed, which is why it's worth determining before building the appeal.
Volari identifies ERISA-governed denials and uses the federal levers they carry — the right to plan documents and the specific basis for the denial — to build appeals a generic template would miss.
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