Group health plans and insurers of non-grandfathered plans will have until plan years beginning on or after January 1, 2012 to comply with certain internal claim and appeal rules under new DOL guidance (Technical Release 2011-01) which extends and modifies an enforcement grace period now in place under the Patient Protection and Affordable Care Act (PPACA).
In September 2010, the DOL issued Technical Release 2010-02 which established the grace period, and set it to expire on July 1, 2011. T.R. 2011-01 now extends that grace period, with limited modifications, until plan years beginning on or after January 1, 2012. The grace period does not apply to all the additional internal claim and appeal process standards identified in the 2010 interim, final regulations; nor does it apply to PPACA’s external review requirements. In addition, the grace periods do not affect the disclosure requirements still in effect for ERISA-covered plans under the DOL’s 2000 claim procedure regulation and/or under Part 1 of ERISA.
In T.R. 2011-01, the DOL also announced its intent to jointly issue in the near future amendments to the 2010 interim final regulations on the PPACA claim and appeal requirements.
Grandfathered plans are not subject to the new claim and appeal requirements.
In September 2010, the DOL issued Technical Release 2010-02 which established the grace period, and set it to expire on July 1, 2011. T.R. 2011-01 now extends that grace period, with limited modifications, until plan years beginning on or after January 1, 2012. The grace period does not apply to all the additional internal claim and appeal process standards identified in the 2010 interim, final regulations; nor does it apply to PPACA’s external review requirements. In addition, the grace periods do not affect the disclosure requirements still in effect for ERISA-covered plans under the DOL’s 2000 claim procedure regulation and/or under Part 1 of ERISA.
In T.R. 2011-01, the DOL also announced its intent to jointly issue in the near future amendments to the 2010 interim final regulations on the PPACA claim and appeal requirements.
Grandfathered plans are not subject to the new claim and appeal requirements.
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