H.R. 9737: Consumer Health Claim Assistance Act

This bill would create a new Benefits Assistance Program inside the Department of Labor to help people with employee health and other welfare benefit plans understand and claim their benefits.

What the new program would do

By January 1, 2027, the Secretary of Labor would have to set up the program within the Employee Benefits Security Administration. The program would be designed to help participants, beneficiaries, and health care providers dealing with benefit denials or other problems under employee welfare benefit plans.

• Take in inquiries and complaints about denied claims, plan terms, and possible violations of ERISA rules.
• Help people understand their rights to benefits and the options for internal appeals and external review.
• Directly assist people in filing appeals and working through the review process.
• Refer complaints to the right enforcement or oversight entities when a plan may be violating the law.
• Provide training and technical support to Department of Labor staff who handle these issues.
• If a state consumer assistance office or ombudsman referred the case, inform that office of the outcome.

The Department of Labor would also have to file an annual report to Congress with data on the number of complaints, the type of assistance provided, how much money was involved, how much the program cost, referrals made, recoveries obtained, how long assistance takes, and any recommendations for more resources or higher filing fees.

New filing fees for certain health and welfare plans

The bill would add a new filing fee for administrators of single-employer employee welfare benefit plans when they file annual reports or certain notices with the Department of Labor.

• $250 for plans with fewer than 100 participants.
• $500 for plans with 100 to 499 participants.
• At least $1,000 for plans with 500 or more participants.

The Labor Secretary could set higher fees by regulation, and any higher fee schedule would have to rise as plan size increases. The bill also says these fees cannot be paid using plan assets.

Money collected from these fees would be used for ERISA enforcement and to support the new Benefits Assistance Program. At least half of the collected money would have to go toward running the program.

New notice requirement for some plans

For single-employer welfare benefit plans that do not have to file an annual report, the bill would require the plan administrator to file a yearly notice with the Department of Labor. That notice would have to include:

• The employer’s name
• The number of employees covered
• The total amount of benefits provided
• How the plan is funded, and, if relevant, the names of insurers providing coverage
• The names of service providers that received $5,000 or more in compensation from the plan

These filing-fee and notice rules would apply to plan years ending after January 1, 2027, and the filing-fee provisions would apply to reports and notices filed after that date.

Relevant Companies

None found