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Archived News Release--Caution:
information may be out of date.
For more information call: (202) 219-8921
The U.S. Department of Labor today clarified in a ruling the rights of
millions of workers to important information concerning how their health plan
benefits are calculated.
Many private-sector health plans that provide medical, surgical and
other benefits to millions of workers base benefits on pre-established "usual
and customary" fees or similar schedules.
Workers often may be denied access to underlying schedules, formulas,
methodologies and other information used by plans to calculate benefit
entitlement although the Employee Retirement Income Security Act requires that
workers be given information concerning the benefits paid under their health
plan.
"No right is more valuable than that of giving workers access to
information about plan benefits," said Olena Berg, Assistant Secretary for the
Pension and Welfare Benefits Administration. "The department's ruling is an
important step in preserving rights to plan information, which may protect them
from unnecessary loss of benefits."
The department received a request for an opinion on whether denying
access to such fee schedules violates the law. In advisory opinion 96-14, the
department concluded that plan documents which serve as the basis for
determining benefit amounts must be disclosed when requested. The opinion
concludes that the same principles would apply to the disclosure of schedules
or formulas used in calculating pension benefits.
Advisory opinion 96-14 is available through PWBA's Public Disclosure
Room at 200 Constitution Ave., N.W., Room N5638, Washington, D.C. 20210. The
ruling also will be available on the Internet by Aug. 15, 1996 at
http://www.dol.gov/dol/pwba.
Archived News Release--Caution:
information may be out of date.
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