Human Resources
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DOL Extends Enforcement Grace Period for Certain Internal Claims and Appeals Procedures

The Department of Labor (DOL) released Technical Release 2011-01 on March 18, 2011 that provides an extension of an enforcement grace period relating to certain interim procedures for internal claims and appeals applicable to non-grandfathered group health plans. This delay/relief does not apply to the new external review also applicable to non-grandfathered group health plans. The DOL, Department of Health and Human Services (HHS), and Treasury (the agencies) are reviewing the external review process and may address the issue further in future guidance.

The Patient Protection and Affordable Care Act (Affordable Care Act) (P.L. 111-148) added Section 2719 to the Public Health Service Act (PHSA) that requires all non-grandfathered group health plans and health insurance issuers to comply with a new internal claims and appeals process and external review. The agencies issued interim final regulations to implement this provision on July 23, 2010. Based on comments received on the interim final regulations, on September 20, 2010, the DOL issued Technical Release 2010-02 setting forth an enforcement grace period for compliance with certain new provisions of the internal claims and appeals process until July 1, 2011. Based on further comments from interested parties, the DOL is now issuing Technical Release 2011-01 providing another extension of the enforcement grace period as well as some modifications.

The Aon Hewitt report available below provides an overview of:

  • Technical Release 2010-02;
  • Technical Release 2011-01;
  • External review and model notices;
  • Next steps; and
  • Resources.

DOL Extends Enforcement Grace Period