Does the regulation require that a plan provide claimants with access to or copies of files of other claimants?
No. The regulation requires that a claimant, have access to, and copies of, documents, records and other information relevant to the claimant s claim. For this purpose, the regulation defines as relevant any document, record, or other information that: (i) was relied upon in making the benefit determination; (ii) was submitted, considered, or generated in the course of making the benefit determination, without regard to whether it was relied upon; (iii) demonstrates compliance with the plan s administrative processes and safeguards for ensuring consistent decision making (see Q-B5); or (iv) constitutes a statement of policy or guidance with respect to the group health plan concerning the denied treatment option or benefit for the claimant s diagnosis, without regard to whether it was relied upon in making the benefit determination. See ยงยง 2560.503-1(h)(2)(iii) and 2560.503-1(m)(8). While information and data from various claimants files may have been compiled for purposes of developing
Related Questions
- Does the regulation require that a group health plan provide a claimant with copies of the claimant s medical records relating to his or her benefit claim?
- Does the regulation require that a group health plan provide a claimant with copies of the claimants medical records relating to his or her benefit claim?
- Does the regulation require that a plan provide claimants with access to or copies of files of other claimants?
