Can you authorize exception payments for ERISA groups?

Department of Labor (DOL) regulations do not make it possible for Blue Cross Blue Shield of Michigan (BCBSM) to authorize exception payments for ERISA groups. ERISA requires all similarly situated participants in a group health plan be treated in the same manner. DOL regulations also require plan fiduciaries (including BCBSM and Blue Care Network (BCN) as claim fiduciaries) to verify that all similarly situated participants in a group health plan are treated in the same manner and that all benefits are paid in accordance with the group's plan documents. Thus, unless the group is willing to amend its benefit plan, as evidenced by a signed exception payment form, no exceptions will be made.

BCBSM will make exception payments for self-funded and ERS groups exempted from ERISA regulations.

 

Type of group Eligible for Exception Payments?
Area/industry-rated ERISA No
Area/industry-rated non-ERISA No
Experience-rated ERISA No
Experience-rated non-ERISA Yes
ASC ERISA No
ASC non-ERISA Yes

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