New Regulation Brings Hope for Those Under ERISA
America’s Top ERISA Attorney, Frank N. Darras, says that ERISA (Employee Retirement Income Security Act) – Ruling by the Department of Health and Human Services changes the way employers and insurance providers must disclose fees and outline services under ERISA. This is a welcome change for those wrongfully denied.
On February 9th, 2012, The Department of Health, Human Services and Labor, and Treasury provided their final regulations implementing section 2715 of the Public Health Services Act, a provision of the Affordable Care Act. This ruling changes the way employers and insurance providers must disclose fees and outline services under ERISA (Employee Retirement Income Security Act). The long-awaited ruling is a welcome change for many who have been wrongfully denied coverage under ERISA, says Frank N. Darras, America’s top ERISA attorney.
“The ruling also calms fears that the health care reform law would force people to purchase employer-provided insurance that fell under ERISA, and therefore be subject to its restraints,” says Darras. “Under the Affordable Care Act, employers that have 50 or more workers are mandated to offer health insurance to their employees or be fined. Unknown to most people is that the majority of employer-provided insurance plans fall under ERISA, an act that restricts your ability to sue your insurer for denying treatment you needed.”
Since ERISA was enacted, it has been used as a sword for insurance companies to wrongfully deny insurance coverage and has harmed those it was initially intended to protect. There was great concern that health care reform would force so many people onto ERISA plans that it would lead to limited care. However, this ruling helps protect the average worker from wrongful denial of insurance claims, says Frank N. Darras, America’s top ERISA claim lawyer.
“Starting March 23rd, 2012, Section 2715 will require all group health plans and insurers, including large group, self-funded, and grandfathered plans, to provide a uniform summary of benefits and coverage (SBC) to all applicants and enrollees before any enrollment restriction. The SBC can be in replace of or in addition to the summary plan descriptions (SPD) that are currently in place,” says Darras.
SPD’s, required under ERISA, were often too long to read and incomprehensible to the average reader. Insurance companies could count on the fact that the average person could not understand the language making it easy to later deny claims, says Darras. The new SBC is required to be no longer than 4 pages and in 12-point pica.
The rules that govern when enrollees are notified of changes in their insurance plans have also been changed. Under ERISA, a plan must notify an enrollee of a change within 60 days after it is made. Under 2715, notice must be provided 60 days before a change occurs, says Darras.
“The changes under 2715 will not only protect the average worker from wrongful denial of insurance claims under ERISA, but will allow them to more easily comparison shop for insurance that fits their particular health care needs. In turn, this will enable more accountability and promote competition among insurance providers that will benefit consumers,” says Darras