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5500 Preparer's Manual for 2012 Plan Years

5500 Preparer's Manual for 2012 Plan Years
The premier resource in the field of Form 5500 preparation, 5500 Preparer's Manual will help you handle the required annual Form 5500 filings for both pension benefits and welfare benefit plans.

CCH® BENEFITS — 06/08/10

Health Reform 2010, Claims Appeals Process

from Spencer’s Benefits Reports: For the next few weeks, Spencer’s Benefits Reports will highlight specific provisions in the new health reform law which affect employer-sponsored plans.

Sec. 1001(5), as amended by Sec. 10101(g), of the Affordable Care Act concerns additional claims appeals procedures.

A group health plan and a health insurer must implement an effective process for appeals of coverage determinations and claims. This appeals process must include, at a minimum, the following:

The meaning of “culturally and linguistically appropriate manner” will be defined in regulations.

Use established processes. Until the Department of Labor issues standards for an appeals process, plans must provide claims and appeals processes required in existing DOL regulations.

Health insurers offering individual coverage and any issuers not subject to existing DOL claims appeals rules may initially use claims and appeals procedures under any other applicable law, such as individual state insurance requirements. Insurers are required to update these procedures when the HHS issues new standards.

External review. Group health plans and insurers have two options regarding the implementation of external reviews:

According to America’s Health Insurance Plans (AHIP), all the states and the District of Columbia have a required external claims review process, except Alabama, Idaho, Mississippi, Nebraska, South Dakota, and Wyoming For more information, visit

The HHS has the authority to determine whether the external review process of a plan or insurer, that is in operation as of the date of enactment is in compliance.

Effective date. The provision is effective for plan years beginning on or after Sept. 23, 2010.

CCH Law, Explanation And Analysis Of Health Reform Act Available

CCH’s Law, Explanation And Analysis of the Patient Protection and Affordable Care Act provides the most comprehensive and practical guidance available to professionals needing to make sense of this historic legislation. Included in the online version is the complete text of the law, integrating both the Affordable Care Act and the Health and Education Reconciliation Act. A hard-copy version of the book is available for $149.

For more information or to order the hard-copy version of the book, please call (800) 248-3248 or click Discounts are available for multiple copies.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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