[Federal Register Volume 62, Number 211 (Friday, October 31, 1997)]
[Notices]
[Pages 59003-59007]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-28919]


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DEPARTMENT OF LABOR

Pension and Welfare Benefits Administration


Proposed Extension of Information Collection Request Submitted 
for Public Comment and Recommendations; Health Insurance Portability 
for Group Health Plans

ACTION: Notice.

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SUMMARY: The Department of Labor submits this notice to extend its 
public information collection request (ICR) under the Health Insurance 
Portability and Accountability Act of 1996

[[Page 59004]]

(HIPAA), Pub. L. 104-191, consisting of three distinct ICRs, to the 
Office of Management and Budget (OMB) for review and clearance under 
the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. Chapter 
35). These three ICRs were first published in the Federal Register 
under the Interim Rules implementing the Health Insurance Portability 
Requirements for Group Health Plans on April 8, 1997. 62 FR 16920 
through 16923 (April 8 Interim Rules). In the April 8 publication, the 
Department submitted the group market information collection 
requirements for, among other things, establishing creditable coverage, 
notice of special enrollment rights, and notice of pre-existing 
condition exclusions to OMB for emergency review under the Paperwork 
Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. Chapter 35). OMB 
approved these ICRs through December 31, 1997 under OMB Control numbers 
1210-0103, 1210-0101, and 1210-0102, respectively. Subsequently, the 
Department published the OMB control numbers in the Federal Register. 
62 FR 36204 (July 7, 1997).
    The April 8 Interim Rules contained three distinct ICRs. The ICRs 
on group health plans' obligations regarding Establishing Prior 
Creditable Coverage and Notice of Enrollment Rights are prescribed by 
the statute.
    The first ICR implements statutorily prescribed requirements 
necessary to establish prior creditable coverage. This is accomplished 
primarily through the issuance of certificates of prior coverage by 
group health plans or by service providers that the group health plans 
contract with in order to provide these documents. In addition, this 
ICR permits plans to use a notice to meet their obligations in 
connection with periods of coverage ending during the transition 
period, October 1, 1996 through May 31, 1997, saving the respondents 
both hours and cost during that period. This ICR also covers the 
requests that certain plans will make regarding additional information 
they require because they are using the Alternative Method of Crediting 
Coverage. Finally, this ICR also includes the occasional circumstances 
where a participant is unable to secure a certificate and needs to 
provides some supplemental form of documentation in order to establish 
prior creditable coverage.
    The second ICR, Notice of Special Enrollment Rights, implements the 
statutorily prescribed disclosure obligation of the plans to inform a 
participant, at the time of enrollment, of the plan's special 
enrollment rules.
    The third ICR, Notice of Pre-Existing Condition Exclusion, concerns 
the disclosure requirements on those plans that contain pre-existing 
condition exclusion provisions. This ICR has two components: a notice 
to all participants at the time of enrollment stating the terms of the 
plan's pre-existing condition provisions, the participant's right to 
demonstrate creditable coverage, and that the plan or issuer will 
assist in securing a certificate if necessary; and notice by the plan 
of its determination that an exclusion period applies to an individual.

1. Establishing Prior Creditable Coverage

    The Department of Labor, as part of its continuing effort to reduce 
paperwork and respondent burden, conducts a preclearance consultation 
program to provide the general public and Federal agencies with an 
opportunity to comment on proposed and/or continuing collections of 
information in accordance with the Paperwork Reduction Act of 1995 
(Pub. L. 104-13, 44 U.S.C. Chapter 34) and 5 CFR 1320.11. This program 
helps to ensure that requested data can be provided in the desired 
format, reporting burden (time and financial resources) is minimized, 
collection instruments are clearly understood, and the impact of 
collection requirements on respondents can be properly assessed. 
Currently, the Pension and Welfare Benefits Administration is 
soliciting comments concerning the proposed extension of a currently 
approved collection of information, Establishing Prior Creditable 
Coverage. A copy of the proposed ICR can be obtained by contacting the 
employee listed below in the contact section of the notice.

DATES: Written comments must be submitted to the office listed in the 
addressee section below on or before December 30, 1997. The Department 
of Labor is particularly interested in comments which:
    <bullet> Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
    <bullet> Evaluate the accuracy of the agency's estimate of the 
burden of the proposed collection of information, including the 
validity of the methodology and assumptions used;
    <bullet> Enhance the quality utility, and clarity of the 
information to be collected; and
    <bullet> Minimize the burden of the collection of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., permitting 
electronic submissions of responses.

ADDRESSES: Gerald B. Lindrew, Office of Policy and Research, U.S. 
Department of Labor, Pension and Welfare Benefits Administration, 200 
Constitution Avenue, Room N-5647, Washington, D.C. 20210. Telephone: 
202-219-4782 (this is not a toll-free number). Fax: 202-219-4745.

SUPPLEMENTARY INFORMATION:

I. Background

    In order to meet HIPAA's goal of improving access to and 
portability of health care benefits, the statute provides that, after 
the submission of evidence establishing prior creditable coverage, a 
subsequent health insurance provider would be limited in the extent to 
which it could use pre-existing condition exclusions to limit coverage. 
This ICR covers the submission of materials sufficient to establish 
prior creditable coverage.

II. Current Actions

    Under 29 CFR 2590.70-5 of the April 8 Interim Rule, a group health 
plan offering group health insurance coverage is obliged to provide a 
written certificate of information suitable for establishing the prior 
creditable coverage of a participant or beneficiary. To the extent that 
a certification is not available or inadequate to prove prior 
creditably coverage, paragraph (c) provides other methods for 
establishing creditable coverage. During the transition period for 
certification under 29 CFR 2590.710(e), plans have the option of 
providing notices regarding participant's rights to certification 
rather than the certification itself; plans then provide certificates 
only to those participants who request them. 29 CFR 2590.701-5(a)(7) 
provides special rules for establishing prior coverage of dependents, 
and 29 CFR 2590.701-5(b) provides guidance on providing evidence of 
coverage to those plans that use the alternative method of crediting 
coverage.
    The April 8 Interim Rules offer model certification and notice 
forms to be used by group health plans and health insurance issuers, 
containing the minimum information mandated by the statute. Based on 
past experience, the staff believes that most of the materials required 
to be exchanged under the certification procedure will be prepared by 
contract service providers such as

[[Page 59005]]

insurance companies and third-party administrators.
    Type of Review: Extension of a currently approved collection.
    Agency: U.S. Department of Labor, Pension and Welfare Benefits 
Administration.
    Title: Establishing Prior Creditable Coverage.
    OMB Number: 1210-0103.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions; Group Health Plans.
    Frequency: On occasion.

                                                     Burden                                                     
----------------------------------------------------------------------------------------------------------------
                                    Total           Total       Average time per   Burden hours                 
             Year                respondents      responses     response (range)      (range)      Cost (range) 
----------------------------------------------------------------------------------------------------------------
1997.........................       2,600,000      51,799,410  3.23 min.........         502,080     $57,180,000
                                                               6.12 min.........         950,710      84,590,000
1998.........................       2,600,000      44,431,970  5.04 min.........         672,120      64,480,000
                                                               11.77 min........       1,569,390     119,310,000
1999.........................       2,600,000      44,399,150  5.27 min.........         702,360      66,310,000
                                                               12.01 min........       1,599,630     121,140,000
----------------------------------------------------------------------------------------------------------------

    Start up costs: It is estimated that the 15,604 plans that will 
perform these functions internally (rather than use a service provider) 
will incur an average cost of $5,000 per plan to revise their automated 
records systems to accommodate this information for a total cost of $78 
million over 10 years beginning in 1997.
    Comments submitted in response to this notice will be summarized 
and/or included in the request for OMB approval of the information 
collection request; they will also become a matter of public record.

2. Notice of Enrollment Rights

    The Department of Labor, as part of its continuing effort to reduce 
paperwork and respondent burden, conducts a preclearance consultation 
program to provide the general public and federal agencies with an 
opportunity to comment on proposed information collection requests 
(ICR) in accordance with the Paperwork Reduction Act of 1995 (Pub. L. 
104-13, 44 U.S.C. Chapter 35) and 5 CFR 1320.11. This program helps to 
ensure that requested data can be provided in the desired format, 
reporting burden (time and financial resources) is minimized, 
collection instruments are clearly understood, and the impact of 
collection requirements on respondents can be properly assessed. 
Currently, the Pension and Welfare Benefits Administration is 
soliciting comments concerning the proposed extension of a currently 
approved collection of information, Notice of Enrollment Rights.
    Dates: Written comments must be submitted to the office listed in 
the addressee section below on or before December 30, 1997.
    The Department of Labor is particularly interested in comments 
which:
    <bullet> Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
    <bullet> Evaluate the accuracy of the agency's estimate of the 
burden of the proposed collection of information, including the 
validity of the methodology and assumptions used;
    <bullet> Enhance the quality, utility, and clarity of the 
information to be collected; and
    <bullet> Minimize the burden of the collection of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., permitting 
electronic submissions of responses.
    Addresses: Gerald B. Lindrew, Office of Policy and Research, U.S. 
Department of Labor, Pension and Welfare Benefits Administration, 200 
Constitution Avenue, Room N-5647, Washington, D.C. 20210. Telephone: 
202-219-4782 (this is not a toll-free number). Fax: 202-219-4745.

I. Background

    In order to improve participants' understanding of their rights 
under an employer's welfare benefit plan, the statute provides that, a 
participant be provided with a description of a plan's special 
enrollment rules on or before the time when a participant is offered 
the opportunity to enroll in a group health plan.

II. Current Actions

    Under 29 CFR 2590.701-6 of the April 8 Interim Rules, a group 
health plan offering group health insurance coverage is obligated to 
provide a description of the plans' special enrollment rules. The 
special enrollment rules generally apply in circumstances when the 
participant initially declined to enroll in the plan, and subsequently 
would like to have coverage.
    The April 8 Interim Rules offer a model form to be used by group 
health plans and health insurance issuers, containing the minimum 
information mandated by the statute. Based on past experience, the 
staff believes that most of the materials required to be supplied under 
this ICR will be prepared by contract service providers such as 
insurance companies and third-party administrators.
    Type of Review: Extension of a currently approved collection.
    Agency: U.S. Department of Labor, Pension and Welfare Benefits 
Administration.
    Title: Notice of Enrollment Rights.
    OMB Number: 1210-0101.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions; Group Health Plans.
    Frequency: On occasion.

[[Page 59006]]



                                                     Burden                                                     
----------------------------------------------------------------------------------------------------------------
                                    Total                                                                       
             Year                respondents        Total       Average time per   Burden hours        Cost     
                                    (000)         responses         response                                    
----------------------------------------------------------------------------------------------------------------
1997.........................       2,600,000         499,080  .50 min..........             750         100,000
1998.........................       2,600,000       7,622,010  .50 min..........          11,430       1,460,000
1999.........................       2,000,000       8,959,380  .50 min..........          13,440       1,720,000
----------------------------------------------------------------------------------------------------------------

    Comments submitted in response to this notice will be summarized 
and/or included in the request for OMB approval of the information 
collection request; they will also become a matter of public record.

3. Notice of Pre-Existing Condition Exclusion

    The Department of Labor, as part of its continuing effort to reduce 
paperwork and respondent burden, conducts a preclearance consultation 
program to provide the general public and federal agencies with an 
opportunity to comment on proposed information collection requests 
(ICR) in accordance with the Paperwork Reduction Act of 1995 (Pub. L. 
104-13, 44 U.S.C. Chapter 35) and 5 CFR 1320.11. This program helps to 
ensure that requested data can be provided in the desired format, 
reporting burden (time and financial resources) is minimized, 
collection instruments are clearly understood, and the impact of 
collection requirements on respondents can be properly assessed. 
Currently, the Pension and Welfare Benefits Administration is 
soliciting comments concerning the proposed extension of a currently 
approved collection of information, Notice of Pre-Existing Condition 
Exclusion. A copy of the proposed ICR can be obtained by contacting the 
employee listed below in the contact section of the notice.
    Dates: Written comments must be submitted to the office listed in 
the addressee section below on or before December 30, 1997.
    The Department of Labor is particularly interested in comment 
which:
    <bullet> Evaluate whether the proposed collection of information is 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
    <bullet> Evaluate the accuracy of the agency's estimate of the 
burden of the proposed collection of information, including the 
validity of the methodology and assumptions used;
    <bullet> Enhance of quality, utility, and clarity of the 
information to be collected; and
    <bullet> Minimize the burden of the collection of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., permitting 
electronic submissions of responses.
    Addresses: Gerald B. Lindrew, Office of Policy and Research, U.S. 
Department of Labor, Pension and Welfare Benefits Administration, 200 
Constitution Avenue, Room N-5647, Washington, DC 20210. Telephone: 202-
219-4782 (this is not a tool-free number). Fax: 202-219-4745.

I. Background

    In order to meet HIPAA's goal of improving portability of health 
care coverage, participants need to understand their rights to show 
prior creditable coverage when entering a group health plan that 
contains pre-existing condition exclusion provisions. In addition, 
participants entering plans that use the alternative method of 
crediting coverage also need to be informed of the plan's provisions. 
Therefore, the Department has determined that plans that contain these 
provisions must disclose that fact to new participants, as well as 
inform individual participants of the extent to which a pre-existing 
condition exclusion applies to them.

II. Current Actions

    29 CFR 2590.701-3(c) requires that a group health plan or health 
insurance issuer offering group health insurance under the plan may not 
impose any pre-existing condition exclusions on a participant unless 
the participant has been notified in writing that the plan contains 
pre-existing condition exclusions, that a participant has the right to 
demonstrate any period of prior creditable coverage, and that the plan 
or issuer will assist the participant in obtaining a certificate of 
prior coverage from any prior plan or issuer, if necessary. 20 CFR 
2590.701-4(c)(4) requires that plans that use the alternative method of 
crediting coverage disclose their method at the time of enrollment in 
the plan. No additional cost of preparing or distributing this 
information has been included in this analysis because plans would only 
pursue this option if it were, on net, less costly than the standard 
method.
    In addition, 29 CFR 2590.701-5(d)(2) requires that before a plan or 
issuer imposes a pre-existing condition exclusion on a particular 
participant, it must first disclose that determination in writing, 
including the basis for the decision, and an explanation of any appeal 
procedure established by the plan or issuer.
    Type of Review: Extension of a currently approved collection.
    Agency: U.S. Department of Labor, Pension and Welfare Benefits 
Administration.
    Title: Notice of Pre-Existing Exclusion Provisions.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions; Group Health Plans.
    Frequency: On occasion.

                                                     Burden                                                     
----------------------------------------------------------------------------------------------------------------
                                    Total           Total       Average time per                                
        Cite/reference           respondents      responses         response       Burden hours        Cost     
----------------------------------------------------------------------------------------------------------------
Notice at time of Enrollment:                                                                                   
    1997.....................       1,261,450         500,800  0.70 min.........           2,470        $180,000
    1998.....................       1,261,450       7,626,880  0.54 min.........          16,300       1,700,000
    1999.....................       1,261,450       8,959,700  0.50 min.........          13,750       1,730,000
Notice of Pre-Existing                                                                                          
 Condition causing lack of                                                                                      
 coverage:                                                                                                      
    1997.....................       1,261,450          57,000  2.27 min.........           1,800         100,000

[[Page 59007]]

                                                                                                                
    1998.....................       1,261,450         862,830  0.84 min.........           6,160         410,000
    1999.....................       1,261,450       1,008,810  0.52 min.........           1,830         210,000
----------------------------------------------------------------------------------------------------------------

    Comments submitted in response to this notice will be summarized 
and/or included in the request for OMB approval of the ICRs; they will 
also become a matter of public record.

    Dated: October 28, 1997.
Gerald B. Lindrew,
Deputy Director, Pension and Welfare Benefits Administration, Office of 
Policy and Research.
[FR Doc. 97-28919 Filed 10-30-97; 8:45 am]
BILLING CODE 4510-29-M