New Appeals and External Review Rules for Self-Funded Plans
Health Care Reform Drill Down
Available immediately
New appeals and external review rules become applicable January 1, 2011 for calendar-year group health plans (even earlier for certain others). There are new requirements for benefit appeals and required external review for benefit denials, plus the DOL’s existing claims rules become applicable to non-ERISA plans (like governmental and church plans). Whether you process claims for your company’s own self-funded plans or as a TPA, join our experts for this 90-minute web seminar as they explain the new compliance challenges.
Originally presented on September 23, 2010.
Seminar Level
Topics Covered
Here’s some of what was covered:
- What group health plans are affected, including exceptions for grandfathered plans and “excepted benefits” (such as limited-scope vision and dental plans, most health FSAs, and certain HRAs).
- Required changes for internal claims procedures, including a shorter urgent care deadline, additional content for denial notices, new criteria for avoiding conflicts of interest, and new strict compliance standard.
- Additional rules for internal appeals, including a claimant’s right to present testimony, plus restrictions on a plan’s ability to consider new information and add reasons for benefit denials.
- New procedures for external reviews, including new deadlines, and procedures for selecting and transmitting required information to external review organizations.
- The new “culturally and linguistically appropriate” standard, which may require that notices be translated into languages other than English.
Note: This seminar will focus on the rules for self-funded employer plans. The rules that apply to insurers for insured employer plans will not be addressed.
Details
Speakers: James D. O’Connell and Kyle T. Murray. Mr. O’Connell is a Partner in Jacobs, Burns, Orlove & Hernandez and a contributing author of EBIA’s ERISA Compliance for Health & Welfare Plans manual. Mr. Murray is an attorney and Editor at EBIA. He is the Editor and a Contributing Author of EBIA’s ERISA Compliance for Health & Welfare Plans manual.
Handouts: A handout of the seminar slides and other information is provided through download.
Viewing Details
- Accessing the recorded web seminar: After you purchase a recorded web seminar, you will receive an email with access information. You and your co-workers may then view the recording as many times as you wish for 60 days. An internet connection is required to view the recording; it can be stopped and started as needed and has a table of contents for easy navigation.
- Recordings are accurate as of the date presented: Our recordings are accurate as of the presentation date of the live seminar. We supplement handout materials with articles from the EBIA Weekly covering significant later developments. You must check the table of contents at your access link for updates before viewing a recorded seminar.
- Please respect our copyright: Do not record the web seminar, share the access link, or duplicate materials. For details on our copyright policy, please visit our Copyright page.
System Requirements for Recorded Web Seminars
EBIA uses WebEx technology for the seminar. You may wish to view system requirements, test your system and download any necessary WebEx software here:
http://www.webex.com/lp/jointest/
If you are not able to complete the WebEx installation, please contact WebEx technical support at (866) 863-3904.
