EBSA Press Release: Labor Department Proposes New Regulation to Give Patients Faster Answers and More Information from Their Health Care Plans [09/09/1998]

Archived News Release — Caution: Information may be out of date.

For more information call: (202) 219-8211

The U.S. Department of Labor today announced a new regulation which will ensure patients a timely, fair internal review when they have a grievance against their health plan and an expedited review for urgent claims.

The proposed regulation, published Wednesday in the Federal Register:

• requires plans to provide enrollees with better disclosure regarding their appeal rights;
• cuts the maximum time health plans have to respond to non-urgent appeals from 90 to 30 days and requires plans to respond to urgent appeals within 72 hours; and
• gives enrollees greater access to records relevant to any denial of benefit claims.

The new rules would apply to over 120 million Americans covered by employer-sponsored health plans.

In addition, the Labor Department published an interim amendment to its rules relating to the way health care plans explain coverage required by the Newborns' and Mothers' Health Protection Act of 1996. The interim amendment tells providers to disclose that a mother and baby may be discharged earlier than the minimum times an insurance plan must cover.

Generally a health plan or health insurance issuer may not restrict benefits for any hospital stay to less than 48 hours for most deliveries and 96 hours for a cesarean section. What may not have been clear in plan disclosures was that an attending provider (such as a physician or licensed nurse midwife) may discharge them sooner, although only after consultation with the mother.

Comments on the proposed regulation and requests for a hearing should be submitted to the U.S. Department of Labor, Pension and Welfare Benefits Administration, 200 Constitution Ave. NW, Room N5669, Washington, D.C. 20210. The proposed new rules are available in the Federal Register of Wednesday, Sept. 9.

Archived News Release — Caution: Information may be out of date.