Health Insurance Claims Fairness Act of 1993

Summary

Health Insurance Claims Fairness Act of 1993 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise claims procedures for employee welfare benefit plans. Establishes: (1) review requirements for qualified welfare plan claims; and (2) standards for treatment of requests to group health plans for preauthorization. Sets additional notice and disclosure requirements, as well as records maintenance requirements, for group health plans and employee welfare plans. Prohibits requiring any party to waive any right under the plan or ERISA as a condition for approval of any qualified welfare plan claim, except as specified in a formal settlement agreement. Directs the Secretary of Labor to establish a qualified welfare plan claims assistance program to provide participants and beneficiaries ongoing assistance in resolving such claims. Treats terms of settlement agreements as terms of the plan. Directs the Secretary to establish an Early Resolution Program (ERP), to be administered in the Department of Labor by a Claims Resolution Board. Sets conditions for eligibility of cases for submission to ERP, including nature of the claim and exhaustion of plan remedies. Allows facilitators to serve on a pro bono basis or be compensated at a fixed fee. Requires attorney referral panels to include pro bono and fee-paid attorneys. Establishes ERP mediation procedures. Treats findings and conclusions as advisory and nonbinding. Provides that participation shall not affect the rights of the parties, unless the case is settled through mediation and the settlement agreement shall be binding on the parties. Revises enforcement provisions to allow: (1) recovery of damages for failure to provide benefits as required under an employee welfare benefit plan; (2) actions for violations of certain ERISA provisions as well as plan provisions; and (3) actions by plans against fiduciaries. Entitles participants or beneficiaries who prevail or substantially prevail in any action or settlement proceeding to attorney's fees or other costs of action. Declares that ERISA does not preempt State laws that provide for: (1) any program making available to participants and beneficiaries ongoing assistance in the resolution of claims under group health plans; or (2) the licensing or regulation of insurance contractors, or sanctions against insurance contractors for unfair claims settlement practices. Directs the Secretary of Labor to study and report to specified congressional committees on the effects of ERISA preemption of State laws relating to employee benefit plans.

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Documents

3 official files

• Introduced in House (text)

  Introduced in House · EN · 28 April 1993

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• Introduced in House (PDF)

  Introduced in House · EN · 28 April 1993

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• Introduced in House

  summary · EN · 28 April 1993

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