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


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HR 1253 RFS 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Insurance Re3 strictions and Limitations Clarification Act of 2009’’. 

4 SEC. 2. DISCLOSURE REQUIREMENTS. 

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

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

7 1182(a)(2)(B)) is amended by inserting before the period 

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

9 ‘‘(i) such limitations and restrictions 

10 are explicit and clear; 

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

12 and restrictions in health insurance cov13 erage offered in connection with the group 

14 health plan, such limitations and restric15 tions have been disclosed in writing to the 

16 plan sponsor in advance of the point of 

17 sale to the plan; 

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

19 insurance coverage provide, to participants 

20 and beneficiaries in the plan in advance of 

21 the point of their enrollment under the 

22 plan, a description of such limitations and 

23 restrictions in a form that is easily under24 standable by such participants and bene25 ficiaries; and 


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HR 1253 RFS 

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

2 of the coverage provide such description to 

3 participants and beneficiaries upon their 

4 enrollment under the plan at the earliest 

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

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

8 Health Service Act (42 U.S.C. 300gg–1(a)(2)(B)) 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) 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 and the issuer 

21 of the group health insurance coverage 

22 make available, to participants and bene23 ficiaries in the plan in advance of the point 

24 of their enrollment under the plan, a de25 scription of such limitations and restricVerDate Nov 24 2008 04:07 Apr 02, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1253.RFS H1253

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HR 1253 RFS 

1 tions in a form that is easily understand2 able by such participants and beneficiaries; 

3 and 

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

5 of the coverage provides such description 

6 to participants and beneficiaries upon their 

7 enrollment under the plan at the earliest 

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

10 (c) INTERNAL REVENUE CODE.—Section 

11 9802(a)(2)(B) of the Internal Revenue Code of 1986 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) the group health plan makes 

17 available, to participants and beneficiaries 

18 in the plan in advance of the point of their 

19 enrollment under the plan, a description of 

20 such limitations and restrictions in a form 

21 that is easily understandable by such par22 ticipants and beneficiaries; and 

23 ‘‘(iii) the plan provides such descrip24 tion to participants and beneficiaries upon 

25 their enrollment under the plan at the earVerDate Nov 24 2008 04:07 Apr 02, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1253.RFS H1253

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HR 1253 RFS 

1 liest opportunity that other materials are 

2 provided.’’. 

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

4 this section shall apply with respect to plan years begin5 ning after 1 year after the date of the enactment of this 

6 Act. 

Passed the House of Representatives March 31, 

2009. 

Attest: LORRAINE C. MILLER, 

Clerk. 


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