New Claims Regulations

[Guest lawdawg]

I understand the new claims rules apply to health plans. Do these rules apply to other types of plans such as disability, AD&D, life, etc...? Any responses greatly appreciated!

[jeanine]

Yes, and as a matter of fact they apply earlier to disability than to health benefits. They were supposed to apply to denials after 1/02 for all types of plans, but the health plan denials were delayed (I think up to one full year) because of the concern that a Patients Bill of Rights law would create 2 different claims and appeals timelines. Now, with no Pt Bill of Rights this is not an issue.

[Guest BenefitsLawyer]

The new claims reg applies to all ERISA plans. (There are no timing changes on pension plan claims and appeals, but there are other changes that apply to pension plans.) The reg also covers all claims and appeals and, in some cases, requires a notice that the benefit has been approved. The reg applies to claims filed on and after 1/1/02, except for group health plans. For the group health plans, it applies on the first day of the first plan that begins on or after 7/1/02, but in no event later than 1/1/03. (I.e., calendar year plans have to comply for claims filed on/after 1/1/03. For other plans, if the plan year begins between 7/1 and 12/31, they have to comply for claims filed on/after the first day of the plan year in '02. If the plan year begins between 1/1 and 6/30, they have to comply for claims filed on/after 1/1/03.)