New IRO Extention Amendment

iiSi is pleased to announce that all of our stop loss carriers have confirmed that they will extend coverage for Independent Review Organization (IRO) decisions pertaining to previously denied medical claims. This policy enhancement provides protection for an employer who is required under the new Patient Protection and Affordable Care Act (PPACA) to cover IRO decisions on overturned denials of previously processed claims.

This extended coverage is applicable for groups written or renewing on or after January 1, 2012. This coverage is provided without any additional premium surcharge. The “denied” date of the initial claim will be considered the “paid” date for policy tracking purposes. Complete details are stated in the actual policy amendment. We are pleased that our carriers have added this coverage to their policies as a means to alleviate potential gaps in employer self-funded medical plans.

Please contact your iiSi Marketing Representative should you need more details.