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Department of Labor Regulations
The U.S. Department of Labor issued final claims procedure and appeal regulations in November 2000 for all groups affected by the Employee Retirement Income Security Act of 1974. The regulations have generally been effective for claims filed on or after July 1, 2002 and contain specific response time and supporting documentation requirements when deciding an appeal.
DOL regulations affect all ERISA group health plans (self-funded, experience-rated, area/industry, and community-related) and apply to all Blue Cross Blue Shield and Blue Care Network of Michigan product lines.
ERISA does exempt certain groups including:
- Government-sponsored group health plans including health plans sponsored by a city, county, state, village, township, public schools, public universities and colleges
- Church-sponsored health plans including entities owned by a church such as a hospital or school
- Nongroup and group conversion
- One-subscriber groups
Health Insurance Portability and Accountability Act of 1996
The Health Insurance Portability and Accountability Act of 1996 is a federal law that was written to protect people who change jobs, are self-employed or who have pre-existing medical conditions. The Administrative Simplification section of the act is intended to improve the efficiency and effectiveness of the national health care delivery system by standardizing the exchange of electronic, administrative and financial data. It is also intended to protect the security and privacy of protected health information.
When HIPAA was signed into law in August 1996, the main focus was on the portability requirements that protected workers who changed jobs against loss of health insurance coverage or from being subject to new health insurance coverage exclusions for pre-existing medical conditions. Many of the portability provisions of HIPAA became effective in 1997 and have since been implemented by BCBSM and BCN. Today, HIPAA attention has shifted to the administrative simplification portion of the law.
