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DOL/EBSA

RIN: 1210-AA61

Publication ID: Spring 1999

Title: Amendments to Employee Benefit Plan Claims Procedures Regulation
Abstract: The Department has proposed to amend the regulation governing the establishment and maintenance of benefit claims procedures by employee benefit plans covered by title I of the Employee Retirement Income Security Act (ERISA). The proposal would establish new standards for the processing of group health and other employee benefit plan claims filed by participants and beneficiaries. In the case of group health plans, as well as certain plans providing disability benefits, the new standards are intended to ensure more timely benefit determinations, improved access to information on which a benefit determination is based, and greater assurance that participants and beneficiaries will be afforded a full and fair review of denied claims.
Agency: Department of Labor(DOL)	Priority: Other Significant
RIN Status: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Final Rule Stage
Major: No	Unfunded Mandates: No
CFR Citation: 29 CFR 2560.503-1
Legal Authority: 29 USC 1133 29 USC 1135

Statement of Need: This regulation is necessary to insure more timely benefit determinations, improve access to information on which a benefit determination is made, and provide greater assurance that participants and beneficiaries will be afforded a full and fair review of denied claims.

Summary of the Legal Basis: Promulgation of this regulation is authorized by sections 503 and 505 of ERISA.

Alternatives: Regulatory alternatives will be developed once determinations have been made with regard to the scope and nature of the amendments which are necessary to update the rules which implement section 503 of ERISA.

Anticipated Costs and Benefits: On the basis of available data, the Department believes that the projected benefits of this proposed regulation would outweigh its projected costs. In particular, updating the existing regulation to address recent changes in the delivery and financing of health care services would improve health care quality by averting harmful, inappropriate delays and denials of health benefits thereby yielding substantial social benefits.

Risks: Failure to issue this regulation would deprive many plan participants and beneficiaries of the benefits of an improved claims review process.

Timetable:

Action	Date	FR Cite
Request for Information--Amendment of Regulations on Plan Claims Procedures	09/08/1997	62 FR 47262
Comment Period End	11/07/1997
Notice of Public Hearing Held on Feb. 17,18 & 19, 1999	01/04/1999	64 FR 65
Final Action	09/00/1999

Regulatory Flexibility Analysis Required: Undetermined	Government Levels Affected: None
Included in the Regulatory Plan: Yes
Agency Contact: Susan M. Halliday Pension Law Specialist Department of Labor Employee Benefits Security Administration Room N5668, 200 Constitution Avenue NW, FP Building, Washington, DC 20210 Phone:202 219-7222