DOL Launches Web Page for Participants to File Questions and Complaints About Their Retirement and Health Plans | Practical Law

DOL Launches Web Page for Participants to File Questions and Complaints About Their Retirement and Health Plans | Practical Law

The US Department of Labor (DOL) launched a new consumer assistance web page for retirement and health plan participants to ask questions about their benefits and file complaints if they believe that their benefits have been improperly denied.

DOL Launches Web Page for Participants to File Questions and Complaints About Their Retirement and Health Plans

by PLC Employee Benefits & Executive Compensation
Published on 11 Nov 2011USA (National/Federal)
The US Department of Labor (DOL) launched a new consumer assistance web page for retirement and health plan participants to ask questions about their benefits and file complaints if they believe that their benefits have been improperly denied.
On November 10, 2011, the DOL's Employee Benefits Security Administration (EBSA) announced the launch of its new consumer assistance web page, which allows retirement, health and other welfare plan participants to:
  • Ask EBSA questions about their benefits.
  • Receive assistance when they believe their benefits have been improperly denied.
The new system, which is available in Spanish, is intended to provide more efficient service to individuals seeking assistance. Requests for assistance can also be submitted by plan service providers (including third-party administrators and attorneys), plan sponsors and government agencies. In addition to general resources, publications and links to important topics on retirement and health plan issues, the web page allows users to contact an EBSA benefits advisor for help by selecting one of the following options:
  • Ask a Question.
  • Submit a Complaint.
  • Report a Problem.
Each of these options links to a form that can be filled out and submitted online or printed and mailed to EBSA. The form requests information about the user, the type of plan the user is asking about and the issue(s) the user is concerned about, which may include:
  • Eligibility for employer sponsored benefits.
  • Obtaining documents or statements from the plan.
  • Plan noncompliance with legal requirements, including ERISA, HIPAA and the Affordable Care Act (ACA).
  • Plan operation, bankruptcy and merger or acquisition issues.
  • COBRA notices and benefits.
The form also includes fields for providing contact information about the plan or the employer, including whether the plan contact is an employer, insurer, service provider/plan administrator or union. The form instructs users to attach all relevant documentation, including plan documents, summary plan descriptions (SPDs) and copies of claims, benefits statements and correspondence with the plan administrator.
The system automatically routes requests to the appropriate regional office based on the user's zip code, and EBSA benefit advisors will respond to any questions or complaints within three business days.

Practical Implications

Employers should be aware that complaints submitted through the consumer assistance web page can ultimately lead to EBSA enforcement investigations. Notably, the web page indicates that valid complaints that cannot be resolved through informal dispute resolution can result in enforcement activity. In the last year, EBSA opened 900 formal investigations of retirement and health plans after benefit advisors referred complaints from participants that EBSA could not resolve informally.
In addition, two points about the web page's interaction with the ACA deserve mention:
  • The consumer assistance web page expressly invites participants and others to submit inquiries regarding plan compliance with the ACA.
  • This program should not be confused with the health insurance consumer assistance ombudsman programs established under the ACA, which are intended, among other things, to:
    • educate individuals of their rights and responsibilities regarding group health plan and health insurance coverage;
    • assist individuals in filing appeals under a group health plan's internal procedures;
    • provide information about external review procedures; and
    • assist individuals with group health plans or health insurance enrollment by providing information, referral, and assistance.
For more information on claims procedures for retirement plans and health plans, see respectively Claims Procedure Requirements for Retirement and Certain Other ERISA Plans Checklist and Claims Procedure Requirements for Group Health Plans Checklist.
For information on compliance with the requirements for health plan added under the ACA, including the consumer assistance ombudsman programs, see Effective Dates and Summary of Key Provisions under the Affordable Care Act (ACA) Chart.