Health Care Alert: Navigating Health Care Reform (September 17, 2010)
New Guidance on Internal Claims Procedures and External Reviews Under PPACA Might Be the Best Reason to Maintain Grandfathered Plan Status


Section 2719 of the Public Health Service Act ("PHS Act"), which was added by the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the "Act"), sets forth standards for both internal claims and appeals and external review processes.  The standards apply to group health plans and issuers offering individual and group policies, but do not apply to grandfathered plans or policies or excepted benefits under the Health Insurance Portability and Accountability Act of 1996 (e.g., stand-alone dental and vision plans and certain health flexible spending accounts), and retiree-only plans.

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