What do employers need to consider regarding healthcare benefits? The enactment of the Affordable Care Act (ACA) marks the latest step in a continuing shift from virtually no federal regulation of employer-sponsored health insurance to extensive substantive and administrative requirements. This regulation initially included the reporting, disclosure, and claims procedure requirements enacted in the Employee Retirement Income Security Act (ERISA). Through the years, additional federal requirements were added, including portability and coverage guarantees, minimum maternity stays, mental health parity, required coverage of reconstructive surgery following a covered mastectomy, coverage of adoptees, and pediatric vaccine requirements. During the same period, there was a large increase in state insurance law benefit mandates.