[Federal Register Volume 62, Number 111 (Tuesday, June 10, 1997)]
[Rules and Regulations]
[Pages 31695-31696]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14894]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

45 CFR Part 148

[BPD-882-CN2]


Individual Market Health Insurance Reform: Portability From Group 
to Individual Coverage; Federal Rules for Access in the Individual 
Market; State Alternative Mechanisms to Federal Rules; Correction

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Interim final rule; correction.

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SUMMARY: This document corrects an interim rule and a previous 
correction to the interim rule published in the Federal Register of 
April 8, 1997 that implement the health insurance portability, 
availability, and renewability provisions of the Health Insurance 
Portability and Accountability Act of 1996 in the individual health 
insurance market.

EFFECTIVE DATE: These corrections are effective on April 8, 1997.

FOR FURTHER INFORMATION CONTACT: Michelle Bruggy, (410) 786-4675.

Correction

    I. In the interim rule, FR document 97-8217, beginning on page 
16985 in the Federal Register of April 8, 1997, make the following 
corrections:
    a. On page 16986, in column 2, in the first paragraph under ``I. 
Summary of Recent Legislation'', the phrase ``Sections 101 through 
103'' is corrected to read ``Sections 101, 102, and 401'' and, in the 
last paragraph, the phrase ``substantially fails to'' is corrected to 
read ``fails to substantially''.
    b. On page 16987, in column 1, in the first paragraph under the 
first bullet, the following amendments are made:
    1. The reference to ``Part 146'' is corrected to read ``Part 144''.
    2. The reference to ``IHS'' is corrected to read ``the Indian 
Health Service''.
    c. On page 16989, column 3, the first paragraph of the Certificate 
of Individual Health Insurance Coverage is corrected to read as 
follows:

    *Important--This certificate provides evidence of your prior 
health coverage. You may need to furnish this certificate if you 
become eligible under a group health plan that excludes coverage for 
certain medical conditions that you have before you enroll. This 
certificate may need to be provided if medical advice, diagnosis, 
care, or treatment was recommended or received for the condition 
within the 6-month period prior to your enrollment in the new plan. 
If you become covered under a group health plan, check with the plan 
administrator to see if you need to provide this certificate. You 
may also need this certificate to buy, for yourself or your family, 
an insurance policy that does not exclude coverage for medical 
conditions that are present before you enroll.
* * * * *
    d. On page 16989, column 3, item 7 of the Certificate of Individual 
Health Insurance Coverage is corrected to read as follows:
* * * * *
    7. If the individual(s) identified in items 2 and 4 has (have) 
at least 18 months of creditable coverage (disregarding periods of 
coverage before a 63-day break), check here ______ and skip items 8 
and 9.
* * * * *


Sec. 148.102  [Corrected]

    e. On page 16996, in column 1, in Sec. 148.102, the following 
corrections are made:
    1. A new heading is added for paragraph (a)(1) to read ``Scope.''.
    2. A new heading is added for paragraph (a)(2) to read 
``Applicability.''.
    3. Paragraph (b) is corrected to read as follows:
* * * * *
    (b) Effective dates--(1) General effective date. Except as provided 
in paragraph (b)(2) of this section, and Sec. 148.128 (State 
flexibility in individual market reforms--alternative mechanisms), the 
requirements of this part apply to health insurance coverage offered, 
sold, issued, renewed, in effect, or operated in the individual market 
after June 30, 1997, regardless of when a period of creditable coverage 
occurs.
    (2) Effective date for certification requirements--(i) General 
rule. Subject to the transitional rule in Sec. 148.124(b)(4)(iii), the 
certification requirements of Sec. 146.115 of this subchapter apply to 
events occurring after June 30, 1996.
    (ii) Period covered by certificate. A certificate is not required 
to reflect coverage before July 1, 1996.
    (iii) No certificate before June 1, 1997. No certificate must be 
provided before June 1, 1997.

[[Page 31696]]

Sec. 148.120  [Corrected]

    f. On page 16996, in column 2, in Sec. 148.120(c)(1), a new heading 
is added to read ``General rule.''
    g. On page 16997, in column 3, in Sec. 148.120(f)(3), in Example 2, 
line 11, the word ``converge'' is corrected to read ``coverage''.


Sec. 148.122  [Corrected]

    h. On page 16998, in column 1, in Sec. 148.122(c)(1), the phrase 
``terms of health insurance coverage'' is corrected to read ``terms of 
the health insurance coverage''.
    i. On page 16998, in column 2, in Sec. 148.122(e)(2), line 3, the 
word ``insurance'' is corrected to read ``issuance''.


Sec. 148.124  [Corrected]

    j. Beginning on page 16998, in column 3, in Sec. 148.124, the 
following corrections are made:
    1. In paragraph (a)(2)(i), the word ``regulated'' is corrected to 
read ``required''.
    2. A new paragraph (a)(2)(iii) is added to read as follows:
* * * * *
    (a) * * *
    (2) * * *
    (iii) Short-term, limited duration coverage defined in Sec. 144.103 
of this subchapter.
* * * * *
    3. Paragraph (b)(1) introductory text is corrected as follows:
    i. The word ``dependents,'' is corrected to read ``dependents''.
    ii. The phrase ``for the following'' is corrected to read ``as 
follows''.
    4. In paragraph (b)(1)(ii), the following corrections are made:
    i. In lines 1 and 2, the phrase ``A request for a certificate'' is 
corrected to read ``Requests for certificates''.
    ii. In line 13, the word ``promptly'' is corrected to read ``by the 
earliest date that the issuer, acting in a reasonable and prompt 
fashion, can provide the certificate''.
    iii. In line 16, the phrase ``previously received'' is corrected to 
read ``previously received a certificate under this paragraph 
(b)(1)(ii) or''.
    5. In paragraph (b)(2)(i)(A), the phrase ``the HCFA)'' is corrected 
to read ``HCFA).''.
    6. In paragraph (b)(2)(i)(B) introductory text, the phrase ``if the 
following occurs'' is corrected to read ``if all of the following 
occur''.
    7. On page 16999, in column 1, in paragraph (b)(2)(iii), line 2, 
the word ``any'' is corrected to read ``an''.
    8. On page 16999, in column 2, in paragraph (b)(3)(i), line 16, the 
phrase ``dependent does not reside at'' is corrected to read 
``dependent's last known address is different than''.
    9. On page 16999, in column 3, in paragraph (b)(4)(iii), the 
following corrections are made:
    i. In the heading, the phrase ``before July 1,'' is corrected to 
read ``through June 30,''.
    ii. In paragraph (b)(4)(iii)(A), line 9, the word ``provided'' is 
corrected to read ``described''.
    iii. In paragraph (b)(4)(iii)(B), lines 9 and 10, the phrase ``If 
an issuer responsible for providing a certificate does not provide'' is 
corrected to read ``If a certificate does not include''.
    iv. Paragraph (b)(4)(iii)(C) is corrected to read as follows:
* * * * *
    (b) * * *
    (4) * * *
    (iii) * * *
    (C) Demonstrating a dependent's creditable coverage. See paragraph 
(d)(3) of this section for special rules to demonstrate dependent 
status.
* * * * *
    v. Paragraph (b)(4)(iii)(E) is removed.
    10. New paragraph (b)(5) is added to read as follows:
* * * * *
    (b) * * *
    (5) Optional notice. This paragraph applies to events described in 
paragraph (b)(1)(i) of this section, that occur after September 30, 
1996, but before June 1, 1997. An issuer offering individual health 
insurance coverage is deemed to satisfy paragraphs (b)(1) and (b)(2) of 
this section if a notice is provided in accordance with the provisions 
of Sec. 146.125 (e)(3)(ii) through (e)(3)(iv) of this subchapter.
* * * * *
    11. On page 17000, in column 1, paragraph (c)(2) is corrected to 
read as follows:
* * * * *
    (c) * * *
    (2) Information to be disclosed. The prior entity must identify to 
the requesting entity the categories of benefits under which the 
individual was covered and with respect to which the requesting entity 
is using the alternative method of counting creditable coverage, and 
the requesting entity may identify specific information that the 
requesting entity reasonably needs to determine the individual's 
creditable coverage with respect to any of those categories. The prior 
entity must promptly disclose to the requesting entity the creditable 
coverage information that was requested.
* * * * *


Sec. 148.128  [Corrected]

    k. Beginning on page 17001, in column 2, in Sec. 148.128, the 
following corrections are made:
    1. In paragraph (c)(2), the reference to ``paragraph (e)(4)(1)'' is 
corrected to read ``paragraph (e)(4)''.
    2. In paragraph (e)(2), a new heading is added to read ``An 
acceptable alternative mechanism.''.
    3. On page 17001, in column 3, in paragraph (e)(4)(ii)(B), the 
words ``are effective'' are removed.
    4. On page 17002, in column 2, in paragraph (h), the phrase ``on 
any basis other than a mechanism'' is corrected to read ``on any basis 
other than that a mechanism''.


Sec. 148.202  [Corrected]

    l. On page 17003, in column 3, in Sec. 148.202(i)(1), the phrase 
``the Administrator or other office imposing the penalty'' is corrected 
to read ``HCFA''.


Sec. 148.220  [Corrected]

    m. On page 17004, in column 1, in Sec. 148.220(b)(4), the term 
``MedSup'' is corrected to read ``MedSupp''.


Sec. 148.128  [Corrected]

    II. In the interim rule; correction, FR document 97-9124, in the 
Federal Register of April 8, 1997, on page 17005, in column 3, remove 
amendatory instruction 4 that corrects Sec. 148.128 and add in column 2 
immediately after amendatory instruction b. the following:
    c. On page 17001, in column 1, in Sec. 148.128(a)(2)(i) 
introductory text and (a)(2)(ii)(B), the phrase ``part 144'' is 
corrected to read ``title 27 of the PHS Act''.

    Authority: Secs. 2701 through 2763, 2791, and 2792 of the PHS 
Act, 42 U.S.C. 300gg through 300gg-63, 300gg-91, and 300gg-92.

    Dated: June 2, 1997.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 97-14894 Filed 6-9-97; 8:45 am]
BILLING CODE 4120-01-P