DOL Issues Safe Harbor for Internal Claims and Appeals Processes

The departments of Labor, Treasury, and Health and Human Services issued Technical Release 2010-02 on September 20, 2010. The Release provides an enforcement grace period until July 1, 2011, to give group health care plans and insurance issuers more time to comply with regulations on new internal claims and appeals procedures. On July 22, 2010, the departments released regulations standardizing and strengthening the process by which consumers can appeal medical coverage or claims denials by their health insurance. The rules apply to nongrandfathered health plans and are effective for plan years beginning on or after Sept. 23. The release said that the Labor Department and Internal Revenue Service will not take any enforcement action against a group health plan, and HHS will not take any enforcement action, during the grace period, against a self-funded nonfederal governmental health plan, that is working in good faith to implement such additional standards but does not yet have them in place. The agencies also released a series of FAQs addressing a range of other topics under the health reform law, including compliance with the rules, grandfathered plans, internal and external reviews processes, and dependent care coverage.