Health Care Reform

Internal and External Review

For plan years beginning on or after September 23, 2010, non-grandfathered health plans must comply with new claims procedures, including improved internal claim review procedures and a new requirement for external review. Insured plans must comply with state external review processes. Self-funded plans (or insured plans in states that do not have external review laws) must comply with new federal external review rules.

 

Note: The internal and external claims review standards only apply to certain types of health plans, such as major medical insurance. Under the Health Care Reform statute and federal agency guidance published to date, they do not apply to HIPAA excepted benefits, such as disability, cancer, hospital indemnity, or accident insurance. Click here for more information about the types of benefits that are exempt from the Health Care Reform plan design mandates.

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Internal and External Claims Review Hot Topics & FAQs

American Fidelity Assurance Company does not provide tax or legal advice.

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Health Care Reform Timeline

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