Consumer Health Claim Assistance Act

The Consumer Health Claim Assistance Act establishes a new Benefits Assistance Program within the Department of Labor's Employee Benefits Security Administration, aiming to improve access to benefits under employee welfare benefit plans. Operational by January 1, 2027, this program will receive inquiries and complaints from participants, beneficiaries, and healthcare providers concerning adverse benefit determinations and alleged plan violations. The Program's duties include assisting individuals in understanding their benefit rights, navigating internal appeals and external reviews, and directly aiding in the filing of appeals for denied benefits. It will also refer potential violations to appropriate entities and provide training to Department staff, with an annual report detailing its activities and impact to ensure transparency and inform future improvements. To fund these initiatives, the bill introduces new filing fees for single-employer welfare benefit plans, payable when submitting annual reports or notices. These fees vary based on plan size, ranging from $250 to at least $1,000, and cannot be paid using plan assets. Crucially, at least 50 percent of the collected funds are specifically earmarked to support the operations of the Benefits Assistance Program, with the remainder allocated to general ERISA enforcement. Additionally, the legislation amends ERISA to require single-employer welfare benefit plans not otherwise mandated to file annual reports to submit a minimum notice to the Secretary of Labor. This notice must include vital information such as the employer's name, number of covered employees, funding method, and details of service providers. These provisions, including the new filing fees and notice requirements, are set to take effect for filings and plan years after January 1, 2027.