How do I make an appeal as a member of an ERISA self-funded group?
Department of Labor regulations generally affect appeals for self-funded ERISA groups in the following ways:
- Members must be provided with a "full and fair review" of all adverse benefit decisions
- A member must be afforded at least 180 days from the initial adverse determination to file an appeal
- A member must not be required to file more that two appeals before he or she may bring a civil action
- A person who made the adverse benefit determination that is the subject of the appeal or his subordinate must not conduct the appeal