On August 17, 2012 the Department of Health and Human Services’ (“HHS”) Center for Medicare and Medicaid Services released Technical Guidance for Non-Federal Governmental Plans regarding notices regarding the plan’s internal claims and appeals process. Under the Public Health Service Act (“PHS Act”), non-grandfathered group health plans are required to have an effective internal claims and appeals process, and must issue certain disclosures regarding the process. Among the required disclosures is a statement of the claimant’s right to bring a civil action following review of an adverse benefit determination. However, the private right of action is not available to participants or beneficiaries of non-federal governmental plans. Thus, HHS has determined that it will not enforce the requirement that non-federal governmental plans provide notice of the ERISA private right of action, or that they provide contact information for the EBSA or a State Department of Insurance as part of the notice.
For more information about the Technical Guidance, click here.
Author: Conchita Lozano
