Legal Alert: Health Care Reform Regulations - Internal Claims and Appeals and External Review Processes


The Departments of Health and Human Services, Labor, and Treasury have published guidance regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets under the Patient Protection and Affordable Care Act (PPACA). The guidance includes Interim Final Rules published on July 23, 2010, model notices issued by the Department of Labor (DOL), and DOL Technical Release 2010-01 and Technical Release 2010-02 issued on August 23, 2010 and September 20, 2010, respectively. These requirements for internal claims and appeals and external review processes do not apply to grandfathered health plans.

Please see full alert below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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