Federal interim final rules that protect insurance company whistleblowers --employees subjected to retaliation for opposing or reporting violations of the Affordable Care Act -- took effect February 23, 2013. Title I of the act includes a range of insurance company accountability requirements; some are required currently, while others will be phased in by 2014.
Current practices subject to the new whistleblower rules include:
• Refusing to cover children under age 18 with pre-existing conditions;
• Discontinuing dependent coverage for those under age 26;
• Denying or rescinding coverage based on non-fraudulent application errors or technical mistakes;
• Setting lifetime dollar-value coverage limits;
• Failing to simplify appeals or create external review processes; and
• Failing to cover preventive care such as mammograms in newly-issued policies.
Whistleblowers who believe they have been subject to workplace retaliation must file complaints with the U.S. Labor Department’s Office of Safety and Health Administration within 180 days after learning of adverse job actions. Among other thing, insurer-employers may be ordered to reinstate the employee, restore lost benefits; and pay lost wages and compensatory damages, including attorneys fees.
Employees who file frivolous claims are subject to administrative fines of up to $1,000.
