DoL Outlines New ERISA Health Claims Procedures

December 18, 2001 ( - The Department of Labor has issued detailed new procedures for handling health-insurance claims in government regulated employer health plans.

The new procedures radically change the way benefits are determined in health plans covered by the Employee Retirement Income Security Act of 1974 (ERISA). Among the changes: new standards for initial benefit decisions and appeals and new disclosure rights for patients.

The changes are minimal for pension and welfare benefits plans other than those that provide group health and disability benefits. 

The new claims procedure kicks in for some plans for new claims filed on or after January 1, 2002.  It will not begin to apply to group health plans until the first day of the first plan year beginning on or after July 1, 2002, but not later than January 1, 2003. 

DoL officials also released a question and answer document ( about how to implement the new rules.

– Fred Schneyer