Posts Tagged: Claim and appeal

Significant Changes for Appeal Rules and EOBs

in Affordable Care Act

Previously, on July 23, 2010, DOL, HHS and Treasury issued interim final rules regarding the claim and appeal requirements under the Affordable Care Act.  These new requirements will apply to all non-grandfathered plans beginning January 1, 2011 (for calendar year plans).  Yesterday, DOL updated the rules by releasing two additional pieces of guidance – new Federal external appeal rules for self-insured plans and model notices for all plans. The Federal external appeal rules are contained in Technical Release 2010-01 and require self-insured plans to follow a new mandatory external appeal process, once participants complete the internal claim and appeal process. DOL also issued three model notices… Continue Reading