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What is Section 503 of ERISA?

Section 503 of ERISA sets forth the general guidelines for a plans claims and appeal procedures. It requires that a plan provide adequate written notice of the denial of a claim by a participant or beneficiary (or authorized representative).

What is 29 CFR 2560?

29 CFR Part 2560 - PART 2560RULES AND REGULATIONS FOR ADMINISTRATION AND ENFORCEMENT. 2560.502-1 Requests for enforcement pursuant to section 502(b)(2). 2560.502c-2 Civil penalties under section 502(c)(2).

What is an adverse benefit determination?

A General Overview of the HHS-Administered Federal External Review Process. If a health insurance plan denies a benefit, refuses to pay for a service that has already been received, or rescinds coverage, this is called an adverse benefit determination.

What is an adverse benefit determination under ERISA?

Under the regulation, an adverse benefit determination generally includes any denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit.