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 

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