Benefits assistance program

Part 5 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1131 et seq.) is amended by adding at the end the following new section: 524. Benefits assistance program (a) Establishment Not later than January 1, 2027, the Secretary shall establish, within the Employee Benefits Security Administration of the Department of Labor, a Benefits Assistance Program (in this section, referred to as the Program) to improve access to benefits under employee welfare benefit plans. (b) Duties The Program shall— (1) establish a process for the receipt of inquiries or complaints from participants and beneficiaries, and health care providers (on behalf of participants and beneficiaries), relating to— (A) adverse benefit determinations (as defined under section 2560.503–1(m)(4) of title 29, Code of Federal Regulations, as in effect on the date of enactment of the Consumer Health Claim Assistance Act); and (B) alleged violations of— (i) plan terms; and (ii) any provision of this title; (2) assist participants and beneficiaries in understanding their rights to benefits under their plan and the availability of internal appeals and external review (as such terms are defined under sections 2590.715–2719(a)(2) of title 29, Code of Federal Regulations, as in effect on the date of enactment of the Consumer Health Claim Assistance Act); (3) directly assist participants and beneficiaries in filing appeals for denied benefits and navigating such appeals or reviews; (4) make referrals to appropriate entities regarding any inquiries or complaints relating to adverse benefit determinations by a plan that may violate this title or any other law; (5) provide additional training, technical assistance, and support to Department staff, including benefits advisors, to address adverse benefit determinations or any violations of this title; and (6) if the inquiry or complaint was received as a result of a referral from a State office of health insurance consumer assistance, health insurance ombudsman, or other program that carries out the duties described in section 2793(c) of the Public Health Service Act (42 U.S.C. 300gg–93(c)), inform such office or program of the result of such inquiry or complaint. (c) Annual report The Secretary of Labor shall, on an annual basis, submit to the Committee on Education and Workforce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report, with respect to the Program, on the following: (1) The number of inquiries and complaints received (disaggregated by type of plan, size of plan, and type of assistance provided). (2) The number of participants and beneficiaries who received assistance (disaggregated by type of plan, size of plan, and type of service provided). (3) The dollar amounts of claims for benefits for which assistance was provided (disaggregated by type of plan, size of plan, and type of service provided). (4) The total dollar amount expended to operate the Program and the number of full-time equivalents assigned by the Secretary to operate the Program. (5) The number of referrals to appropriate entities and, when available, the disposition of such enforcement actions. (6) The number and type of any non-monetary recoveries by participants and beneficiaries who received assistance. (7) The average amount of time it takes to provide assistance. (8) Recommendations regarding any additional authority or resources needed to improve the Program, including recommendations on necessary increases in filing fees under section 104(d). (9) Any other data determined appropriate by the Secretary..