I 
111TH CONGRESS 
1ST SESSION H. R. 2457 
To amend the Employee Retirement Income Security Act of 1974, the Public 
Health Service Act, and the Internal Revenue Code to require that 
group health plans and issuers of health insurance coverage provide 
coverage for second opinions. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 18, 2009 
Mrs. DAVIS of California (for herself, Mr. MCCOTTER, Mr. RUSH, Mr. 
WITTMAN, and Mr. HARE) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committees on Education and Labor and Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend the Employee Retirement Income Security Act 
of 1974, the Public Health Service Act, and the Internal 
Revenue Code to require that group health plans and 
issuers of health insurance coverage provide coverage 
for second opinions. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Right to a Second 
Medical Opinion Act of 2009’’. 
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SEC. 2. COVERAGE OF SECOND OPINIONS. 
(a) GROUP HEALTH PLANS.— 
(1) ERISA AMENDMENTS.— 
(A) Subpart B of part 7 of title I of the 
Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1185 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 715. COVERAGE OF SECOND OPINIONS. 
‘‘(a) COVERAGE OF SECOND OPINIONS.—A group 
health plan, and a health insurance issuer that provides 
health insurance coverage in connection with a group 
health plan, shall provide coverage for a second opinion 
(as defined in subsection (b)(1)), if— 
‘‘(1) the second opinion is requested by— 
‘‘(A) a participant or beneficiary; or 
‘‘(B) a health care practitioner (as defined 
in subsection (b)(2))— 
‘‘(i) who, with respect to a medical 
condition, is treating or has proposed a 
treatment plan for the participant or bene-
ficiary; and 
‘‘(ii) who has the consent of the par-
ticipant or beneficiary to make the request; 
and 
‘‘(2)(A) the participant or beneficiary questions 
a diagnosis, treatment plan, surgical procedure, or 
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therapeutic procedure for a medical condition that 
threatens loss of life, quality of life, loss of limb, loss 
of bodily function, loss of cognitive function, or sub-
stantial impairment of the mind or body (including 
a serious chronic condition or infection); 
‘‘(B) the clinical indications with respect to a 
medical condition are not conclusive; 
‘‘(C) a diagnosis for a medical condition is in 
doubt due to conflicting test results; 
‘‘(D) the health care practitioner treating the 
participant or beneficiary for a medical condition is 
unable to diagnose the condition; 
‘‘(E) the treatment plan being used by the par-
ticipant or beneficiary for a medical condition is not 
causing improvement in the condition within an ap-
propriate period of time given the diagnosis and plan 
of care as expected for such condition; or 
‘‘(F) the medical condition under treatment ac-
celerates or continues. 
‘‘(b) COVERAGE OF A SECOND OPINION AND RE-
LATED DEFINITIONS.—For purposes of this section: 
‘‘(1) COVERAGE OF A SECOND OPINION.—The 
term ‘coverage of a second opinion’ means, with re-
spect to a medical condition, coverage for— 
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‘‘(A) at least three appointments for the 
participant or beneficiary with the qualified sec-
ond opinion physician (as defined in paragraph 
(7)) for the purposes of making and reviewing 
a second opinion (as defined in paragraph (8)) 
for the medical condition; and 
‘‘(B) ancillary diagnostic tests conducted 
or ordered by the qualified second opinion phy-
sician for the purpose of making such second 
opinion to the extent such tests would be cov-
ered by the plan or issuer involved if the tests 
were conducted to provide information to a par-
ticipating physician (as defined in paragraph 
(5)) for the purpose of making the initial opin-
ion (as defined in paragraph (3)) with respect 
to the medical condition. 
‘‘(2) HEALTH CARE PRACTITIONER.—The term 
‘health care practitioner’ means a physician or a 
nurse practitioner. 
‘‘(3) INITIAL OPINION.—The term ‘initial opin-
ion’ means, with respect to a medical condition, the 
first opinion for such condition. 
‘‘(4) OPINION.—The term ‘opinion’ means, for 
a medical condition, an opinion respecting the diag-
nosis or treatment plan for the condition that is 
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made by a health care practitioner for a participant 
or beneficiary. 
‘‘(5) PARTICIPATING
PHYSICIAN.—The term 
‘participating physician’ means, with respect to a 
group health plan or an issuer of health insurance 
coverage, a physician who participates in a preferred 
physician network (or similar arrangement) recog-
nized under such coverage of a plan or issuer. 
‘‘(6) PHYSICIAN.—The term ‘physician’ has the 
meaning given such term in section 1861(r)(1) of 
the Social Security Act (42 U.S.C. 1935x(r)(1)). 
‘‘(7) QUALIFIED
SECOND
OPINION
PHYSI-
CIAN.—The term ‘qualified second opinion physician’ 
means, with respect to a medical condition, a physi-
cian who possesses a clinical background, including 
training and expertise or a history of treating pa-
tients, related to the condition. 
‘‘(8) SECOND
OPINION.—The term ‘second 
opinion’ means, with respect to a medical condition, 
an opinion made by a qualified second opinion physi-
cian for a medical condition for which another health 
care practitioner (as defined in paragraph (2)) made 
an initial opinion (as defined in paragraph (3)). 
‘‘(c) FINANCIAL RESPONSIBILITY, TERMS OF COV-
ERAGE, AND LIMITATIONS.— 
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