Group Health Plan Review Standards Act of 1999

Summary

Group Health Plan Review Standards Act of 1999 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans to provide written notice of adverse coverage decisions to participants or beneficiaries and care providers. Requires group health plans to meet specified time limits for: (1) making decisions on requests for benefit payments, advance determination of coverage, and medical necessity determinations; and (2) making coverage decisions relating to accelerated need medical care, and for completing internal reviews of initial denials of such coverage. Requires internal reviews by medical professionals of initial coverage decisions involving: (1) medical appropriateness or necessity; (2) investigational items; or (3) experimental treatment or technology. Allows participants or beneficiaries, under certain conditions, to request external review by an independent medical expert of an adverse coverage decision and reconsideration of the initial review decision. Sets forth: (1) permitted alternatives to required internal reviews and required external reviews; (2) review requirements; and (3) a fiduciary standards compliance requirement.

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Documents

3 official files

• Introduced in House (text)

  Introduced in House · EN · 9 June 1999

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• Introduced in House (PDF)

  Introduced in House · EN · 9 June 1999

  ViewDownloadOpen at official source

• Introduced in House

  summary · EN · 9 June 1999

  Open at official source

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