Grace Period For Adopting Certain Internal Claims & Appeals Procedures For Non-Grandfathered Group Health Plans Extended

The DOL recently issued guidance that extends the grace period for amending non-grandfathered group health plans to comply with certain provisions of the new internal claims and appeals procedures. Prior guidance provided an original amendment deadline of July 1, 2011 for complying with the following provisions:

1. The 24-hour time frame for deciding urgent care claims;
2. The requirement to provide notices in a culturally and linguistically appropriate manner;
3. The broader content and specificity requirements for notices to claimants; and
4. The obligation to strictly adhere to all the requirements of the 2010 regulations governing the internal claims and appeals procedures.

According to DOL Technical Release 2011-01, the amendment deadline for calendar year plans with respect to the provisions listed above has been extended until January 1, 2012. Non-calendar year plans, however, must work through a two-part grace period extension. The grace period for items (a), (b), and (d) above, for non-calendar year plans, has been extended until plan years beginning on or after January 1, 2012. The same grace period applies to item (c) above, but solely with regard to the requirement to disclose diagnosis and treatment codes (and their meanings.) The grace period for the remaining content and disclosure requirements of item (c) has been extended only until the first day of the first plan year beginning on or after July 1, 2011.

Please contact your Foster Swift employee benefits professional if you have any questions regarding the foregoing.

• Read full Summer 2011 Employment, Labor & Benefits Quarterly