30 pages. "In 1975, EBSA exempted health plans having fewer than 100 participants from reporting requirements because the agency did not want to create an undue administrative burden. As a result of this exemption, EBSA has collected no information about denials of health claims from self-insured health plans that cover about 79 million participants. Moreover, Form 5500, EBSA's primary information collection tool, did not capture information on denials of health benefit claims. As a result, even the plans that were required to report to EBSA were not required to provide any information on their denials of health benefit claims. Despite this lack of primary knowledge about denials of health benefit claims in self-insured health plans, EBSA has conducted only limited reviews of these self-insured plans for compliance with external review requirements, and it has yet to issue final guidance for independent review organizations (IRO) that decide appeals of denied claims."  MORE >>