Who pays a death benefit, how long does an employer group life claim take, and will my health plan or Medicare pay anything when someone dies?

A death benefit comes from a life insurance policy, or from a plan that promises one. A health plan is a different promise. Every Marketplace plan must cover ten essential health benefits. The list runs like this. Ambulatory patient services. Emergency services. Hospitalization. Pregnancy, maternity and newborn care. Mental health and substance use disorder services. Prescription drugs. Rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care. A death benefit is not on that list [1].

So the answer is the same three ways. A Marketplace plan does not pay one. The pages quoted here do not say what Medicare covers for this. Whether a job-based health plan pays anything here is not in the sources quoted — ask the plan. What a health plan covers is medical care, and the list above is what a Marketplace plan must cover [1].

If the life insurance comes through your employer and the plan is covered by ERISA, the federal claims rule sets the clock. It is the general clock, not the health or disability one. The plan must tell you about an adverse benefit determination no later than 90 days after it gets the claim. It may take longer only if it decides special circumstances require it. The written extension notice must reach you before the first 90 days end. It must state those circumstances and the date the plan expects to decide. The extension cannot run past another 90 days [2].

If the plan denies, you get at least 60 days to appeal. The clock starts when you receive the notice. On request and free of charge, you may have reasonable access to, and copies of, all documents, records and other information relevant to the claim [3]. On review the plan decides no later than 60 days after it gets your request. One extension is allowed for special circumstances. It cannot run past another 60 days. And it must be noticed to you in writing before the first 60 days end [4].

Read 29 CFR 2560.503-1(f)(1), (h)(2) and (i)(1) at the govinfo links quoted here for the group life clocks, and read «What Marketplace health insurance plans cover» at healthcare.gov for what a health plan does cover. Then ask the plan administrator for the plan document and the claim procedure.