HHS Will Not Enforce the Requirement that Non-Federal Governmental Plans Provide Notice of the ERISA Private Right of Action
On August 17, 2012 the Department of Health and Human Services’ (“HHS”) Center for Medicare and Medicaid Services released Technical Guidance for Non-Federal Governmental Plans regarding notices regarding the plan’s internal claims and appeals process. Under the Public Health Service Act (“PHS Act”), non-grandfathered group health plans are required to have an effective internal claims and appeals process, and must issue certain disclosures regarding the process. Among the required disclosures is a statement of the claimant’s right to bring a civil action following review of an adverse benefit determination. However, the private right of action is not available to participants or beneficiaries of non-federal governmental plans. Thus, HHS has determined that it will not enforce the requirement that non-federal governmental plans provide notice of the ERISA private right of action, or that they provide contact information for the EBSA or a State Department of Insurance as part of the notice.
For more information about the Technical Guidance, click here.
Author: Conchita Lozano
