Burden Estimates - Appeals

Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers (CMS-10338)

OMB: 0938-1099

IC ID: 193861

Documents and Forms

Document Name Document Type
Model Notice of Internal Adverse Benefit Determination_01.29.25.docx Other-Model - Notice of Internal Adverse Benefit Determination
Model Notice of Adverse Benefit Determination_01.29.25.docx Other-Model Notice of Adverse Benefit Determination
Model Notice of Final External Review Decision_01.29.25.docx Other-Model Notice of Final External Review Decision