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

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 information collection requirements are necessary for the Federal external review process to provide an independent external review as requested by claimants.

The latest form for 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) expires 2023-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Internal Claims and Appeals and External Review Procedures
Burden Estimates - Appeals Other-Model - Notice of Internal Adverse Benefit Determination

All Historical Document Collections

202512-0938-019	Reinstatement without change of a previously approved collection	2026-02-12
202504-0938-011	No material or nonsubstantive change to a currently approved collection	2025-04-11
202412-0938-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-12-12
202205-0938-010 Approved without change	Reinstatement without change of a previously approved collection	2022-05-09
202110-0938-001 Approved with change	Revision of a currently approved collection	2021-10-07
201911-0938-014 Approved without change	Extension without change of a currently approved collection	2019-11-30
201606-0938-004 Approved without change	Revision of a currently approved collection	2016-07-01
201503-0938-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-03-26
201303-0938-001 Approved with change	Reinstatement without change of a previously approved collection	2013-03-04
201106-0938-021 Approved with change	Revision of a currently approved collection	2011-06-22
201009-0938-010 Approved without change	Revision of a currently approved collection	2010-09-23
201009-0938-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2010-09-21
201008-0938-015 Approved with change	Revision of a currently approved collection	2010-08-20
201008-0938-014 Approved without change	Revision of a currently approved collection	2010-08-20
201007-0938-005 Preapproved	New collection (Request for a new OMB Control Number)	2010-07-20