Health plans granted delay on appeals provision of reform law

Federal regulators have agreed to give some health plans until July 1, 2011, to comply with internal appeals and external review rules set to go into effect Thursday.

New "safe harbor" guidance from the departments of Labor and Health and Human Services delays enforcement action against group health plans and health insurance issuers in the group or individual market who are "acting in good faith" to implement the new rules, created by the healthcare reform act. The plans, according to a memo to members of America's Health Insurance Plans (AHIP), must show they are doing their best to: 

  • respond to urgent-care claims within 24 hours after receipt of the claim; 
  • provide notices in a "culturally and linguistically appropriate" manner;
  • include diagnosis and procedure codes and other content on notices of adverse determination; and
  • allow claimants to initiate external review or legal action if the plan or insurer fails to strictly adhere to all requirements.

AHIP had requested the safe harbor out of concern that health plans would face "significant challenges" in complying with the new rules by Thursday. 

In addition, the new guidance also addresses grandfathered plans, dependent coverage for children up to age 26 and coverage for out-of-network emergency services.