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Text of Technical Guidance: Content of Notices of Adverse Benefit Determinations for Beneficiaries in Non-Federal Governmental Health Plans (PDF)
Center for Consumer Information & Insurance Oversight Link to more items from this source
[Official Guidance]
Aug. 19, 2012
"Section 2719 of the Public Health Service Act (PHS Act) requires that non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage have an effective internal claims and appeals process.... This document sets forth an enforcement safe harbor with respect to the content of the adverse benefit determinations and final internal adverse benefit determinations issued to participants and beneficiaries in group health plans that are non-federal governmental plans (and health insurance coverage offered in connection with such plans).... HHS will not enforce the requirement that non-federal governmental plans provide notice of the ERISA private right of action. Similarly, HHS will not enforce the requirement that non-federal governmental plans provide contact information for the EBSA or a State Department of Insurance. This safe harbor is applicable as long as [certain notices are provided by the plan]."

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