Questions & answers · Health insurance
I filed a claim with my employer health plan. How long does the plan have to decide?
Health insuranceHow to fileChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(i) View original ↗
In short
- The time depends on the kind of claim.
- Care you already got: the plan has 30 days to tell you a denial.
- Urgent care: 72 hours.
What this means
For a job-based group health plan, the federal rule sets time limits. They are counted from the day the plan receives your claim. For urgent care, the plan must decide as soon as possible and no later than 72 hours. If something is missing, it must tell you within 24 hours what it needs [1].
If you need approval before care, the limit is no later than 15 days. The plan can extend one time by up to 15 days, if it tells you before the first 15 days end [2].
For care you already received, a denial notice is due no later than 30 days. The plan can extend one time by up to 15 days [3].
Your next step
Write down the date the plan received your claim and add 30 days (care already received) or 15 days (approval before care). If that date passes with no word, ask the plan in writing.
Deadline: 72 hours, 15 days (+15) or 30 days (+15), by claim type.
Check it yourself
The sources do not say which forms or papers to send - your plan's claim form and member booklet do: "Don't know yet".
Where this comes from (3)
[1] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(i) · checked 2026-11-06
not later than 72 hours after receipt of the claim by the plan … not later than 24 hours after receipt of the claim by the plan, of the specific information necessary to complete the claim.
[2] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(iii)(A) · checked 2026-11-06
not later than 15 days after receipt of the claim by the plan. This period may be extended one time by the plan for up to 15 days
[3] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(iii)(B) · checked 2026-11-06
not later than 30 days after receipt of the claim. This period may be extended one time by the plan for up to 15 days
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
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