[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1253 Engrossed in House (EH)]

111th CONGRESS
  1st Session
                                H. R. 1253

_______________________________________________________________________

                                 AN ACT


 
 To require that limitations and restrictions on coverage under group 
  health plans be timely disclosed to group health plan sponsors and 
timely communicated to participants and beneficiaries under such plans 
                in a form that is easily understandable.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Insurance Restrictions and 
Limitations Clarification Act of 2009''.

SEC. 2. DISCLOSURE REQUIREMENTS.

    (a) ERISA.--Section 702(a)(2)(B) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1182(a)(2)(B)) is amended by inserting 
before the period at the end the following: ``so long as--
                            ``(i) such limitations and restrictions are 
                        explicit and clear;
                            ``(ii) in the case of such limitations and 
                        restrictions in health insurance coverage 
                        offered in connection with the group health 
                        plan, such limitations and restrictions have 
                        been disclosed in writing to the plan sponsor 
                        in advance of the point of sale to the plan;
                            ``(iii) the plan sponsor of the health 
                        insurance coverage provide, to participants and 
                        beneficiaries in the plan in advance of the 
                        point of their enrollment under the plan, a 
                        description of such limitations and 
                        restrictions in a form that is easily 
                        understandable by such participants and 
                        beneficiaries; and
                            ``(iv) the plan sponsor and the issuer of 
                        the coverage provide such description to 
                        participants and beneficiaries upon their 
                        enrollment under the plan at the earliest 
                        opportunity that other materials are 
                        provided.''.
    (b) PHSA.--Section 2702(a)(2)(B) of the Public Health Service Act 
(42 U.S.C. 300gg-1(a)(2)(B)) is amended by inserting before the period 
at the end the following: ``so long as--
                            ``(i) such limitations and restrictions are 
                        explicit and clear;
                            ``(ii) in the case of such limitations and 
                        restrictions in health insurance coverage 
                        offered in connection with the group health 
                        plan, such limitations and restrictions have 
                        been disclosed in writing to the plan sponsor 
                        in advance of the point of sale to the plan;
                            ``(iii) the plan sponsor and the issuer of 
                        the group health insurance coverage make 
                        available, to participants and beneficiaries in 
                        the plan in advance of the point of their 
                        enrollment under the plan, a description of 
                        such limitations and restrictions in a form 
                        that is easily understandable by such 
                        participants and beneficiaries; and
                            ``(iv) the plan sponsor and the issuer of 
                        the coverage provides such description to 
                        participants and beneficiaries upon their 
                        enrollment under the plan at the earliest 
                        opportunity that other materials are 
                        provided.''.
    (c) Internal Revenue Code.--Section 9802(a)(2)(B) of the Internal 
Revenue Code of 1986 is amended by inserting before the period at the 
end the following: ``so long as--
                            ``(i) such limitations and restrictions are 
                        explicit and clear;
                            ``(ii) the group health plan makes 
                        available, to participants and beneficiaries in 
                        the plan in advance of the point of their 
                        enrollment under the plan, a description of 
                        such limitations and restrictions in a form 
                        that is easily understandable by such 
                        participants and beneficiaries; and
                            ``(iii) the plan provides such description 
                        to participants and beneficiaries upon their 
                        enrollment under the plan at the earliest 
                        opportunity that other materials are 
                        provided.''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning after 1 year after the date 
of the enactment of this Act.

            Passed the House of Representatives March 31, 2009.

            Attest:

                                                                 Clerk.
111th CONGRESS

  1st Session

                               H. R. 1253

_______________________________________________________________________

                                 AN ACT

 To require that limitations and restrictions on coverage under group 
  health plans be timely disclosed to group health plan sponsors and 
timely communicated to participants and beneficiaries under such plans 
                in a form that is easily understandable.