Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers
ICR 201007-0938-005
OMB: 0938-1099
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1099 can be found here:
Affordable Care Act Internal
Claims and Appeals and External Review Procedures for
Non-grandfathered Group Health Plans and Issuers and Individual
Market Issuers
New
collection (Request for a new OMB Control Number)
The information collection
requirements included in the claims procedure regulation ensure
that participants and beneficiaries (claimants) receive adequate
information regarding the plan's claims procedures and the plan's
handling of specific benefit claims. Participants and beneficiaries
need to understand plan procedures and plan decisions in order to
appropriately request benefits and/or appeal benefit denials. The
recordkeeping requirement will allow a participant, beneficiary, or
Federal or state official to inspect important information
regarding an issuers' internal claims and appeals processes and
request and receive documents free of charge.
The Patient Protection
and Affordable Care Act, Public Law 111-148, (the Affordable Care
Act) was enacted by President Obama on March 23, 2010. As part of
the Act, Congress added PHS Act section 2719, which provides rules
relating to internal claims and appeals and external review
processes. These interim final regulations set forth rules
implementing PHS Act section 2719 for internal claims and appeals
and external review processes. Due to the urgency and short time
frames associated with these provisions, HHS does not have
sufficient time to allow for the usual comment timeframe allotted
in the PRA process.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.