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Frequently Asked Questions

Frequently Asked Questions

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Question: What is the Benefit Claims Procedure Regulation (29 CFR 2560.503-1)?

Answer: The claims procedure regulation changes the minimum procedural requirements for the processing of benefit claims for all employee benefit plans covered under ERISA, although the changes are minimal for pension and welfare benefit plans other than those that provide group health and disability benefits. For group health and disability benefit claims, the regulation substantially changes the procedures for benefit determinations. Among other things, it creates new procedural standards for initial and appeal-level decisions, new time frames for decision making, and new disclosure rights for claimants.

You can find frequently asked questions on this regulation at EBSA's Web site on Benefit Claims.