I 

111TH CONGRESS 

1ST SESSION H. R. 1253 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 3, 2009 

Mr. BURGESS (for himself and Mr. STUPAK) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committees on Education and Labor and Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

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 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Insurance Re5 strictions and Limitations Clarification Act of 2009’’. 


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1 SEC. 2. DISCLOSURE REQUIREMENTS. 

2 (a) ERISA.—Section 702(a)(2)(B) of the Employee 

3 Retirement Income Security Act of 1974 (29 U.S.C. 

4 1182(a)(2)(B)) is amended by inserting before the period 

5 at the end the following: ‘‘so long as— 

6 ‘‘(i) such limitations and restrictions 

7 are explicit and clear; 

8 ‘‘(ii) in the case of such limitations 

9 and restrictions in health insurance cov10 erage offered in connection with the group 

11 health plan, such limitations and restric12 tions have been disclosed in writing to the 

13 plan sponsor in advance of the point of 

14 sale to the plan; 

15 ‘‘(iii) the plan sponsor of the health 

16 insurance coverage provide, to participants 

17 and beneficiaries in the plan in advance of 

18 the point of their enrollment under the 

19 plan, a description of such limitations and 

20 restrictions in a form that is easily under21 standable by such participants and bene22 ficiaries; and 

23 ‘‘(iv) the plan sponsor and the issuer 

24 of the coverage provide such description to 

25 participants and beneficiaries upon their 

26 enrollment under the plan at the earliest 


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1 opportunity that other materials are pro2 vided.’’. 

3 (b) PHSA.—Section 2702(a)(2)(B) of the Public 

4 Health Service Act (42 U.S.C. 300gg–1(a)(2)(B)) is 

5 amended by inserting before the period at the end the fol6 lowing: ‘‘so long as— 

7 ‘‘(i) such limitations and restrictions 

8 are explicit and clear; 

9 ‘‘(ii) in the case of such limitations 

10 and restrictions in health insurance cov11 erage offered in connection with the group 

12 health plan, such limitations and restric13 tions have been disclosed in writing to the 

14 plan sponsor in advance of the point of 

15 sale to the plan; 

16 ‘‘(iii) the plan sponsor and the issuer 

17 of the group health insurance coverage 

18 make available, to participants and bene19 ficiaries in the plan in advance of the point 

20 of their enrollment under the plan, a de21 scription of such limitations and restric22 tions in a form that is easily understand23 able by such participants and beneficiaries; 

24 and 


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1 ‘‘(iv) the plan sponsor and the issuer 

2 of the coverage provides such description 

3 to participants and beneficiaries upon their 

4 enrollment under the plan at the earliest 

5 opportunity that other materials are pro6 vided.’’. 

7 (c) INTERNAL REVENUE CODE.—Section 

8 9802(a)(2)(B) of the Internal Revenue Code of 1986 is 

9 amended by inserting before the period at the end the fol10 lowing: ‘‘so long as— 

11 ‘‘(i) such limitations and restrictions 

12 are explicit and clear; 

13 ‘‘(ii) the group health plan makes 

14 available, to participants and beneficiaries 

15 in the plan in advance of the point of their 

16 enrollment under the plan, a description of 

17 such limitations and restrictions in a form 

18 that is easily understandable by such par19 ticipants and beneficiaries; and 

20 ‘‘(iii) the plan provides such descrip21 tion to participants and beneficiaries upon 

22 their enrollment under the plan at the ear23 liest opportunity that other materials are 

24 provided.’’. 


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1 (d) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply with respect to plan years begin3 ning after 1 year after the date of the enactment of this 

4 Act. 

Æ 


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