Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the PPACA

This regulation outlines the requirements for the following processes of group health plans and health insurance coverage in the group and individual market: (1) internal claims and appeals, and (2) the external review processes. These updated processes become effective for plan years (policy years in the individual market) beginning on or after September 23, 2010. Key provisions of this regulation include: how insurers can comply with the new internal claims and appeals process, guidance for external review processes and whether insurers must follow state or federal procedures, and notice requirements for appeals processes. This regulation is not applicable to grandfathered group health plans.

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