Consumer Health Claim Assistance Act
Sponsored By: Representative DeSaulnier, Mark [D-CA-10]
Introduced
Summary
Would create a Benefits Assistance Program in the Department of Labor to help participants and beneficiaries challenge denied health benefits under ERISA and to guide appeals and external reviews. The Program would be established not later than January 1, 2027.
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- People covered by employer health plans would get direct help understanding their rights and filing internal appeals and external reviews. The Program would accept inquiries from participants, beneficiaries, and health care providers acting on their behalf.
- Health care providers acting for patients could submit complaints about adverse benefit determinations and get referrals to state consumer assistance offices or other appropriate entities. The Program would also provide training and technical support to Department of Labor staff who advise claimants.
- Administrators of single-employer plans would pay annual filing fees when they file reports. Fees are $250 for plans with fewer than 100 participants, $500 for plans with 100 to 499 participants, and at least $1,000 for larger plans. Fees may not come from plan assets and at least 50 percent of collected funds must support the Program. Plans not required to file annual reports must submit a notice with employer name, covered employee count, funding method, any insurers, and service providers paid $5,000 or more.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 1 costs, 0 mixed.
More help for denied health claims
This bill would require the Department of Labor to set up a Benefits Assistance Program inside EBSA by January 1, 2027. The Program would accept complaints about adverse benefit determinations from plan participants, beneficiaries, and health care providers acting for them. It would help people understand their rights, assist with internal appeals and external reviews, and directly help file appeals and navigate the process. The Program would make referrals to other entities, train and support Department staff and benefits advisors, and inform referring state consumer assistance offices of outcomes. The Secretary would send Congress an annual report with counts of inquiries and assistance, dollars of claims helped, program spending and staff (FTEs), referrals and outcomes, recoveries, average help time, and recommendations.
New filing fees for employer plans
This bill would require administrators of single‑employer welfare plans to pay a filing fee when they file an annual report or certain notices for filings after January 1, 2027. Fees would be $250 for plans with under 100 participants, $500 for 100–499 participants, and at least $1,000 for larger plans, with participant counts measured as of the close of the prior plan year. The Secretary could set higher fees by regulation and must adopt a scale that rises with participant counts. Fees could not be paid from plan assets. Collected fees would fund enforcement of ERISA Title I and operations of the Benefits Assistance Program, with at least 50 percent used for the Program and funds available without fiscal year limits. Administrators of single‑employer plans not otherwise filing an annual report would have to file a yearly notice listing employer name, covered employees, aggregate benefits, funding method and issuers, and service providers paid $5,000 or more.
Sponsors & CoSponsors
Sponsor
DeSaulnier, Mark [D-CA-10]
CA • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov