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  • 37 Pdfsam AAHCA BillText 071409

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    This document outlines requirements for fair marketing practices and grievance/appeals mechanisms for health insurers offering qualified health benefit plans (QHBPs). It requires the Commissioner to establish uniform marketing standards for QHBP offering entities and mandates that entities provide timely grievance and appeals processes established by the Commissioner. It also specifies that the internal claims and appeals process for QHBPs initially incorporate certain existing federal regulations for employee benefit plans.

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    This document outlines requirements for fair marketing practices and grievance/appeals mechanisms for health insurers offering qualified health benefit plans (QHBPs). It requires the Commissioner to establish uniform marketing standards for QHBP offering entities and mandates that entities provide timely grievance and appeals processes established by the Commissioner. It also specifies that the internal claims and appeals process for QHBPs initially incorporate certain existing federal regulations for employee benefit plans.

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    37 Pdfsam AAHCA BillText 071409

    Uploaded by

    Anonymous VRG5peRat
    This document outlines requirements for fair marketing practices and grievance/appeals mechanisms for health insurers offering qualified health benefit plans (QHBPs). It requires the Commissioner to establish uniform marketing standards for QHBP offering entities and mandates that entities provide timely grievance and appeals processes established by the Commissioner. It also specifies that the internal claims and appeals process for QHBPs initially incorporate certain existing federal regulations for employee benefit plans.

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    © All Rights Reserved
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    of 1

    37

    periodic updating of the benefit standards previously 1


    adopted under this section. 2
    (3) REQUIREMENT.The Secretary may not 3
    adopt any benefit standards for an essential benefits 4
    package or for level of cost-sharing that are incon- 5
    sistent with the requirements for such a package or 6
    level under sections 122 and 123(b)(5). 7
    Subtitle DAdditional Consumer 8
    Protections 9
    SEC. 131. REQUIRING FAIR MARKETING PRACTICES BY 10
    HEALTH INSURERS. 11
    The Commissioner shall establish uniform marketing 12
    standards that all insured QHBP offering entities shall 13
    meet. 14
    SEC. 132. REQUIRING FAIR GRIEVANCE AND APPEALS 15
    MECHANISMS. 16
    (a) IN GENERAL.A QHBP offering entity shall pro- 17
    vide for timely grievance and appeals mechanisms that the 18
    Commissioner shall establish. 19
    (b) INTERNAL CLAIMS AND APPEALS PROCESS. 20
    Under a qualified health benefits plan the QHBP offering 21
    entity shall provide an internal claims and appeals process 22
    that initially incorporates the claims and appeals proce- 23
    dures (including urgent claims) set forth at section 24
    2560.5031 of title 29, Code of Federal Regulations, as 25
    VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
    July 14, 2009 (12:51 p.m.)
    F:\P11\NHI\TRICOMM\AAHCA09_001.XML
    f:\VHLC\071409\071409.140.xml (444390|2)

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