Not a Member?  Become One Today!

HR Magazine, March 2001: More Leeway for Workers, More Work for HR - Other Important Changes for Group Health Plans

Copyright Image Permissions
HR Magazine,   March 2001 Vol. 46, No. 3

The final regulations make other important changes that apply principally to group health plans. These changes include the following:

  • An authorized representative of a claimant must be allowed to act on behalf of the claimant. For purposes of an urgent care claim, the regulations specifically provide that a health care professional with knowledge of a claimant’s medical condition must be treated as the claimant’s representative. A plan may establish reasonable procedures for determining whether an individual has been authorized to act on behalf of a claimant.

  • The final regulations make health maintenance organization (HMO) plans fully subject to the new procedural standards.

  • Group health plans governed by state insurance law may be subject to the state’s review procedure to evaluate and resolve disputes involving adverse determinations.
Copyright Image Permissions

 Web Extras



Swipe for more!