employeers responsibility in regards to and employees medical claim
MariaI
3 Posts
My company offers it employees medical coverage thru various insurance carriers. The employer pays 95% of the premium. A common problem is that when an employee submits a medical claim for themselves or one of their dependants and it is denied they seek the help of the employer in fighting their claim. My question is ... What is the company's responsibility regarding the employees medical claim (or a claim submitted by one of their dependants) in regards to fighting the insurance company to approve the claim? If there is no legal responsibility what if any disclaimer can I attach to the employee benefits manual explaining the employers obligations?
Comments
I don't think a disclaimer is necessary since this type of information is usually contained in the SPD - it's just that the employees fail to READ the manual.
Judging from the size of your business only, I would estimate that you would fall into the category of small businesses and have until next April to be in compliance.
SPD's are the plan documents relative to the benefit being offered. These are the detailed explanations about the plan benefits and utilization.