To amend title I of the Employee Retirement Income Security Act of 1974 to provide new procedures and access to review for grievances arising under group health plans.
Requires group health plans to meet specified time limits for: (1) making decisions on requests for benefit payments, advance determination of coverage, and medical necessity determinations; and (2) making coverage decisions relating to accelerated need medical care, and for completing internal reviews of initial denials of such coverage.
Requires internal reviews by medical professionals of initial coverage decisions involving: (1) medical appropriateness or necessity; (2) investigational items; or (3) experimental treatment or technology.
Allows participants or beneficiaries, under certain conditions, to request external review by an independent medical expert of an adverse coverage decision and reconsideration of the initial review decision.
Sets forth: (1) permitted alternatives to required internal reviews and required external reviews; (2) review requirements; and (3) a fiduciary standards compliance requirement.
Introduced in House
Introduced in House
Referred to the House Committee on Education and the Workforce.
Referred to the Subcommittee on Employer-Employee Relations.
Subcommittee Consideration and Mark-up Session Held.
Forwarded by Subcommittee to Full Committee (Amended) by the Yeas and Nays: 11 - 7.
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