termine that either a shorter period of hospital stay, 
or outpatient treatment, is medically appropriate. 
‘‘(b) PROHIBITION ON CERTAIN MODIFICATIONS.— 
In implementing the requirements of this section, a group 
health plan may not modify the terms and conditions of 
coverage based on the determination by a participant or 
beneficiary to request less than the minimum coverage re-
quired under subsection (a). 
‘‘(c) NOTICE.—A group health plan shall provide no-
tice to each participant and beneficiary under such plan 
regarding the coverage required by this section in accord-
ance with regulations promulgated by the Secretary. Such 
notice shall be in writing and prominently positioned in 
any literature or correspondence made available or distrib-
uted by the plan and shall be transmitted— 
‘‘(1) in the next mailing made by the plan to 
the participant or beneficiary; or 
‘‘(2) as part of any yearly informational packet 
sent to the participant or beneficiary; 
whichever is earlier. 
‘‘(d) SECONDARY CONSULTATIONS.— 
‘‘(1) IN GENERAL.—A group health plan that 
provides coverage with respect to medical and sur-
gical services provided in relation to the diagnosis 
and treatment of cancer shall ensure that full cov-
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erage is provided for secondary consultations by spe-
cialists in the appropriate medical fields (including 
pathology, radiology, and oncology) to confirm or re-
fute such diagnosis. Such plan or issuer shall ensure 
that full coverage is provided for such secondary 
consultation whether such consultation is based on a 
positive or negative initial diagnosis. In any case in 
which the attending physician certifies in writing 
that services necessary for such a secondary con-
sultation are not sufficiently available from special-
ists operating under the plan with respect to whose 
services coverage is otherwise provided under such 
plan or by such issuer, such plan or issuer shall en-
sure that coverage is provided with respect to the 
services necessary for the secondary consultation 
with any other specialist selected by the attending 
physician for such purpose at no additional cost to 
the individual beyond that which the individual 
would have paid if the specialist was participating in 
the network of the plan. 
‘‘(2) EXCEPTION.—Nothing in paragraph (1) 
shall be construed as requiring the provision of sec-
ondary consultations where the patient determines 
not to seek such a consultation. 
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‘‘(e) PROHIBITION ON PENALTIES.—A group health 
plan may not— 
‘‘(1) penalize or otherwise reduce or limit the 
reimbursement of a provider or specialist because 
the provider or specialist provided care to a partici-
pant or beneficiary in accordance with this section; 
‘‘(2) provide financial or other incentives to a 
physician or specialist to induce the physician or 
specialist to keep the length of inpatient stays of pa-
tients following a mastectomy, lumpectomy, or a 
lymph node dissection for the treatment of breast 
cancer below certain limits or to limit referrals for 
secondary consultations; 
‘‘(3) provide financial or other incentives to a 
physician or specialist to induce the physician or 
specialist to refrain from referring a participant or 
beneficiary for a secondary consultation that would 
otherwise be covered by the plan involved under sub-
section (d); or 
‘‘(4) deny to a woman eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan solely for the purpose of avoiding 
the requirements of this section.’’. 
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(b) CLERICAL AMENDMENT.—The table of contents 
for chapter 100 of such Code is amended by inserting after 
the item relating to section 9812 the following: 
‘‘Sec. 9813. Required coverage for minimum hospital stay for mastectomies, 
lumpectomies, and lymph node dissections for the treatment of 
breast cancer and coverage for secondary consultations.’’. 
(c) EFFECTIVE DATES.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply with respect to plan years be-
ginning on or after the date of enactment of this 
Act. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group 
health plan maintained pursuant to 1 or more collec-
tive bargaining agreements between employee rep-
resentatives and 1 or more employers ratified before 
the date of enactment of this Act, the amendments 
made by this section shall not apply to plan years 
beginning before the date on which the last collective 
bargaining agreements relating to the plan termi-
nates (determined without regard to any extension 
thereof agreed to after the date of enactment of this 
Act). For purposes of this paragraph, any plan 
amendment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement added by 
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this section shall not be treated as a termination of 
such collective bargaining agreement. 
Æ 
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