Consumer Health Claim Assistance Act
- Sponsor
- Rep. DeSaulnier, Mark [D-CA-10]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Jul 16, 2026
Bottom line
The bill aims to improve consumer access to health benefits by creating a dedicated assistance program funded by new fees on employers sponsoring health plans, while also increasing transparency for some plans.
What it actually does
This bill establishes a Benefits Assistance Program (BAP) within the Department of Labor's Employee Benefits Security Administration (EBSA) to help participants, beneficiaries, and healthcare providers navigate health benefit claims and appeals under employee welfare benefit plans. It also imposes new annual filing fees on single-employer welfare benefit plans to fund this program and other ERISA enforcement activities, and requires certain plans not currently filing annual reports to submit a basic notice with key information.
Proponents argue
Supporters argue the bill will empower consumers and healthcare providers by providing direct assistance in challenging denied health claims, ensuring participants receive the benefits they are entitled to under ERISA plans. They contend that the new program will address a critical gap in consumer protection, especially for complex health claims, and that the funding mechanism ensures the program is self-sustaining and places the burden on the plans themselves.
Opponents contend
Critics might argue that imposing new filing fees on single-employer welfare benefit plans, particularly smaller ones, adds an unnecessary administrative and financial burden on employers, potentially leading to increased healthcare costs or disincentivizing the offering of such plans. They might also question the efficiency and necessity of a new federal program, suggesting existing mechanisms or state-level programs could be strengthened instead.
The bill is relatively short and its core provisions are straightforward, making it accessible for an informed reader to evaluate within a reasonable timeframe.
Section 2, new section 524(a) of ERISA
Establishment of Benefits Assistance Program (BAP)
This provision mandates the Secretary of Labor to establish a Benefits Assistance Program within the Employee Benefits Security Administration (EBSA) by January 1, 2027. The program's primary goal is to enhance access to benefits provided by employee welfare benefit plans, creating a dedicated federal resource for individuals facing challenges with their health benefits.
Supporters argue
Supporters argue that a dedicated federal program is essential to provide consistent, expert assistance to individuals struggling with complex health benefit denials, ensuring a uniform standard of consumer protection across all ERISA plans.
Critics contend
Critics might argue that creating a new federal program could lead to bureaucratic inefficiencies and overlap with existing state-level consumer assistance programs, potentially duplicating efforts or creating confusion.
Tradeoffs
The tension lies between the desire for comprehensive federal consumer protection and concerns about expanding federal bureaucracy and potential redundancy with state efforts.
Section 2, new section 524(b) of ERISA
Duties of the Benefits Assistance Program
This section outlines the specific responsibilities of the BAP, including receiving inquiries and complaints from participants, beneficiaries, and healthcare providers regarding adverse benefit determinations or alleged plan violations. It also requires the program to assist individuals in understanding their rights, filing appeals, making referrals for violations, providing training to Department staff, and informing state offices of inquiry results when referrals originate from them.
Section 2, new section 524(c) of ERISA
Annual Reporting Requirements for BAP
This provision mandates the Secretary of Labor to submit an annual report to Congress detailing the BAP's activities. The report must include data on the number of inquiries and complaints received, participants assisted, dollar amounts of claims for which assistance was provided, program expenditures, referrals, non-monetary recoveries, average assistance time, and recommendations for program improvement.
Section 3(a), new section 104(d)(1) of ERISA
Imposition of New Filing Fees on Single-Employer Welfare Benefit Plans
This provision requires administrators of single-employer welfare benefit plans to pay a filing fee to the Secretary of Labor when submitting an annual report or a new notice (as described in Section 4). This establishes a new, dedicated revenue stream intended to fund the Benefits Assistance Program and other ERISA enforcement activities.
Section 3(a), new section 104(d)(2) of ERISA
Fee Structure and Regulatory Authority
This provision sets a tiered fee structure based on the number of participants in a plan: $250 for plans with fewer than 100 participants, $500 for plans with 100 to 499 participants, and not less than $1,000 for plans with 500 or more participants. It also grants the Secretary regulatory authority to require higher fees, with a mandate to establish a fee scale that increases with plan size, allowing for flexibility in funding levels.
Section 3(a), new section 104(d)(4) of ERISA
Use and Availability of Fee Funds
This provision directs the Secretary of Labor to expend the collected fees for ERISA enforcement and to support the operations of the Benefits Assistance Program (BAP). It specifies that these funds are available without fiscal year limitation and that at least 50% must be used for the BAP, ensuring a dedicated and stable funding source for these activities.
Section 4(a), amending section 104(a) of ERISA
Minimum Notice Requirement for Certain Single-Employer Welfare Benefit Plans
This provision requires single-employer welfare benefit plans that are not otherwise required to file an annual report (e.g., certain small, unfunded, or insured plans) to instead file a notice with the Secretary of Labor. This notice must include basic information such as the employer's name, number of covered employees, aggregate benefits provided, funding method, and names of service providers receiving $5,000 or more in compensation.
The bill defines 'adverse benefit determinations' and 'internal appeals and external review' by referencing specific sections of the Code of Federal Regulations (29 CFR 2560.503-1(m)(4) and 29 CFR 2590.715-2719(a)(2)).
Section 2, new section 524(b)(1)(A) and (b)(2) of ERISA
Why it matters:This is standard legislative practice to avoid reprinting lengthy regulatory definitions and to ensure consistency with existing administrative law, leveraging established legal frameworks.
Case for: Using existing regulatory definitions ensures legal consistency and avoids creating new, potentially conflicting interpretations, which streamlines the legislative process and relies on established legal frameworks.
Case against: Requires a reader to consult external regulations to fully understand the precise scope of the Benefits Assistance Program's duties and the types of claims it will address, making the bill less self-contained.
Estimated impact: Ensures the BAP operates within well-understood legal definitions for health claim denials and appeal processes, providing clarity for both the program and beneficiaries.
This provision explicitly prohibits the use of plan assets to pay the newly established filing fees, ensuring that the fees must be paid by the employer or plan sponsor, not from funds held for participant benefits.
Section 3(a), new section 104(d)(3) of ERISA
Why it matters:While not intentionally buried to obscure, its placement within the fee mechanics means a casual reader might miss its significance regarding fiduciary responsibility.
Case for: Proponents argue this is a critical consumer protection measure, ensuring that funds intended for participant benefits are not diverted to cover administrative fees, thereby upholding the fiduciary duty of plan administrators and safeguarding beneficiary assets.
Case against: No specific opposition is typically raised against this provision, as it aligns with general principles of fiduciary responsibility under ERISA. However, it reinforces the financial burden of the fees directly on employers.
Estimated impact: Clarifies the source of funds for fee payment, ensuring employer responsibility and protecting billions of dollars in plan assets from being used for administrative fees.