Fiduciaries of a major Western lumber producer’s group health plan have agreed to settle the U.S. Department of Labor’s (DOL’s) allegations that the plan violated claims procedure and other requirements of the Affordable Care Act (ACA) and the Employee Retirement Income Security Act (ERISA).
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After an investigation by DOL’s Employee Benefits Security Administration (EBSA), the Sierra Pacific Industries Health Benefits Plan agreed to take specific steps to come into compliance with the ACA and ERISA, to pay past benefit claims in compliance with the ACA, and to correct the way it handles future claims.
The EBSA investigation found problems with certain aspects of the plan’s claims processing, with the clarity of plan documents, and with how the plan applied certain procedures for deciding claims. The plan also was operating under the mistaken assumption that it was “grandfathered” under the ACA, according to the agency.