IIB 111th CONGRESS 1st Session H. R. 1253 IN THE SENATE OF THE UNITED STATES April 1, 2009 Received; read twice and referred to the Committee on Health, Education, Labor, and Pensions 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.

1.

Short title

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

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. Lorraine C. Miller, Clerk.