How ACA Modifies ERISA's Benefit Claims Procedures

Law360, New York (October 9, 2012, 1:15 PM EDT) -- The Affordable Care Act amended the Employee Retirement Income Security Act in a variety of ways, creating an array of litigation risks.[1] Among other things, it expanded ERISA’s benefit claims procedures to include external review for plans that are not grandfathered. These nongrandfathered ERISA plans must now provide participants with the option of external, independent claims review following exhaustion of ERISA’s existing internal claims procedures.

External review must be conducted by qualified independent review organizations (IROs) and results in a binding and final administrative benefit determination....
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