IB 

Union Calendar No. 27 

111TH CONGRESS 

1ST SESSION H. R. 1253 

[Report No. 111–62, Part I] 

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 

MARCH 30, 2009 

Reported from the Committee on Energy and Commerce 

MARCH 30, 2009 

Committees on Education and Labor and Ways and Means discharged; committed to the Committee of the Whole House on the State of the Union 

and ordered to be printed 

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 particiVerDate Nov 24 2008 22:22 Mar 30, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H1253.RH H1253

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pants 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’’. 

6 SEC. 2. DISCLOSURE REQUIREMENTS. 

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

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

9 1182(a)(2)(B)) is amended by inserting before the period 

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

11 ‘‘(i) such limitations and restrictions 

12 are explicit and clear; 

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

14 and restrictions in health insurance cov15 erage offered in connection with the group 

16 health plan, such limitations and restric17 tions have been disclosed in writing to the 

18 plan sponsor in advance of the point of 

19 sale to the plan; 

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

21 insurance coverage provide, to participants 

22 and beneficiaries in the plan in advance of 

23 the point of their enrollment under the 

24 plan, a description of such limitations and 


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1 restrictions in a form that is easily under2 standable by such participants and bene3 ficiaries; and 

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

5 of the coverage provide such description to 

6 participants and beneficiaries upon their 

7 enrollment under the plan at the earliest 

8 opportunity that other materials are pro9 vided.’’. 

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

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

12 amended by inserting before the period at the end the fol13 lowing: ‘‘so long as— 

14 ‘‘(i) such limitations and restrictions 

15 are explicit and clear; 

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

17 and restrictions in health insurance cov18 erage offered in connection with the group 

19 health plan, such limitations and restric20 tions have been disclosed in writing to the 

21 plan sponsor in advance of the point of 

22 sale to the plan; 

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

24 of the group health insurance coverage 

25 make available, to participants and beneVerDate Nov 24 2008 22:22 Mar 30, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1253.RH H1253

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1 ficiaries in the plan in advance of the point 

2 of their enrollment under the plan, a de3 scription of such limitations and restric4 tions in a form that is easily understand5 able by such participants and beneficiaries; 

6 and 

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

8 of the coverage provides such description 

9 to participants and beneficiaries upon their 

10 enrollment under the plan at the earliest 

11 opportunity that other materials are pro12 vided.’’. 

13 (c) INTERNAL REVENUE CODE.—Section 

14 9802(a)(2)(B) of the Internal Revenue Code of 1986 is 

15 amended by inserting before the period at the end the fol16 lowing: ‘‘so long as— 

17 ‘‘(i) such limitations and restrictions 

18 are explicit and clear; 

19 ‘‘(ii) the group health plan makes 

20 available, to participants and beneficiaries 

21 in the plan in advance of the point of their 

22 enrollment under the plan, a description of 

23 such limitations and restrictions in a form 

24 that is easily understandable by such par25 ticipants and beneficiaries; and 


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1 ‘‘(iii) the plan provides such descrip2 tion to participants and beneficiaries upon 

3 their enrollment under the plan at the ear4 liest opportunity that other materials are 

5 provided.’’. 

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

7 this section shall apply with respect to plan years begin8 ning after 1 year after the date of the enactment of this 

9 Act. 


pwalker on PROD1PC71 with BILLS
Union Calendar No. 27 

111TH CONGRESS 

1ST SESSION H. R. 1253 

[Report No. 111–62, Part I] 

A BILL 

To require that limitations and restrictions on covstandable. under such plans in a form that is easily under- communicated to participants and beneficiaries closed to group health plan sponsors and timely erage under group health plans be timely disMARCH 30, 2009 

Reported from the Committee on Energy and Commerce 

MARCH 30, 2009 

Committees on Education and Labor and Ways and 

to be printed Whole House on the State of the Union and ordered Means discharged; committed to the Committee of the 


pwalker on PROD1PC71 with BILLS