Benefit Check: Mastering ERISA Claims Procedures from Filing to Final Review

The Section 503-1 ERISA regulation sets forth minimum requirements for employee benefit plan procedures pertaining to claims for benefits by participants and beneficiaries (also referred to as claimants). The claim procedure regulation applies to every type of ERISA plan (as described in ERISA § 4(a)), including almost all employer-sponsored (or employee organization-sponsored) retirement plans, health plans, and other welfare and fringe benefit plans. The regulation does not cover plans that are exempt from ERISA under ERISA § 4(b) (i.e., governmental plans, non-electing church plans, statutorily mandated workers' compensation and disability insurance plans, non-U.S. plans maintained primarily for the benefit of nonresident aliens, and excess benefit plans). Learn more about the minimum requirements

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Related Content

• Claims Procedure ERISA Requirements Checklist (General Rules)
  Review this checklist describing the minimum timing and notice standards for a benefit plan's internal claims procedure under ERISA. The ERISA rules essentially require covered plans to establish and maintain an internal process reasonably designed to ensure a full and fair review of benefit claims and a claimant’s appeal of an adverse determination. 
• Claims Procedure ERISA Requirements Checklist (Group Health Plans)
  Refer to this checklist for the enhanced standards required for a group health plan's benefit claims procedure under ERISA and under the Patient Protection and Affordable Care Act (ACA). Any adverse determination regarding a group health plan claim for benefits must be in writing (except a decision on an urgent care claim may be provided orally if followed up by a written notice within three days) and contain prescribed information, as set forth in this checklist. 

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