Appeals information updated


Appeals information updated

Although the appeals provision of the health care reform law was effective in 2010, the U.S. Department of Labor provided an enforcement grace period until July 2011 for some requirements until additional guidance is issued. We are anticipating further guidance, which we believe may address some requirements that we and other carriers have expressed concern about, including:

· Diagnosis codes and treatment codes ( and their descriptions) on explanation of benefit forms, which raises privacy concerns

· Group-specific language requirements, which put additional responsibilities on customers 

For details on our current implementation efforts, please review the fact sheet that outlines our implementation efforts for both parts of the appeals provision: (1) adverse benefit determinations and (2) appeals process.

New fact sheets outline market reforms in 2014

In 2014, some of the most significant requirements of the health care reform law will take effect. In addition to the availability of exchanges, 2014 will bring changes to health insurance markets, product designs and employer responsibilities. 

We’ve developed a new fact sheet that outline key changes coming in 2014, including:

· Exchanges

· Health plan product framework

· Additional product requirements

· Free choice vouchers

· Rating requirements (small group only)

· Combined risk pool (small group only)

The information in the fact sheet is based on the provisions in the health care reform law. Many of the details about 2014 market reforms will need to be clarified by regulations.