If a group health plan provides for two levels of review following an adverse benefit determination, may the plan use non-binding arbitration as a means for deciding the appealed claim?
Yes. A plan s procedures may provide for arbitration of benefit disputes at one of the two levels of appeal, provided two conditions are met. First, the arbitration must be conducted in a manner that will ensure that the timeframes and notice requirements otherwise applicable to appeals will be satisfied. Second, the arbitration must be non-binding that is, the arbitration may not limit the claimant s ability to challenge the benefit determination in court. See ยง 2560.503-1(c)(4). The regulation also permits a plan to offer binding arbitration to a claimant after completion of the plan s appeal process. See Q-E1 and Q-E2.
Yes. A plans procedures may provide for arbitration of benefit disputes at one of the two levels of appeal, provided two conditions are met. First, the arbitration must be conducted in a manner that will ensure that the timeframes and notice requirements otherwise applicable to appeals will be satisfied. Second, the arbitration must be non-binding that is, the arbitration may not limit the claimants ability to challenge the benefit determination in court. See 2560.503-1(c)(4). The regulation also permits a plan to offer binding arbitration to a claimant after completion of the plans appeal process.
Related Questions
- If a group health plan provides for two levels of review following an adverse benefit determination, may the plan use non-binding arbitration as a means for deciding the appealed claim?
- If a group health plan provides for two levels of review, rather than one, following an adverse benefit determination, what standards, if any, govern the second level of review?
- If a group health plan provides for two levels of review following an adverse benefit determination, within what period must a determination be made at each level?
