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 partici-
pants and beneficiaries under such plans in a form that 
is easily understandable. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Insurance Re-
strictions and Limitations Clarification Act of 2009’’. 
SEC. 2. DISCLOSURE REQUIREMENTS. 
(a) ERISA.—Section 702(a)(2)(B) of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 
1182(a)(2)(B)) is amended by inserting before the period 
at the end the following: ‘‘so long as— 
‘‘(i) such limitations and restrictions 
are explicit and clear; 
‘‘(ii) in the case of such limitations 
and restrictions in health insurance cov-
erage offered in connection with the group 
health plan, such limitations and restric-
tions have been disclosed in writing to the 
plan sponsor in advance of the point of 
sale to the plan; 
‘‘(iii) the plan sponsor of the health 
insurance coverage provide, to participants 
and beneficiaries in the plan in advance of 
the point of their enrollment under the 
plan, a description of such limitations and 
restrictions in a form that is easily under-
standable by such participants and bene-
ficiaries; and 
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‘‘(iv) the plan sponsor and the issuer 
of the coverage provide such description to 
participants and beneficiaries upon their 
enrollment under the plan at the earliest 
opportunity that other materials are pro-
vided.’’. 
(b) PHSA.—Section 2702(a)(2)(B) of the Public 
Health Service Act (42 U.S.C. 300gg–1(a)(2)(B)) is 
amended by inserting before the period at the end the fol-
lowing: ‘‘so long as— 
‘‘(i) such limitations and restrictions 
are explicit and clear; 
‘‘(ii) in the case of such limitations 
and restrictions in health insurance cov-
erage offered in connection with the group 
health plan, such limitations and restric-
tions have been disclosed in writing to the 
plan sponsor in advance of the point of 
sale to the plan; 
‘‘(iii) the plan sponsor and the issuer 
of the group health insurance coverage 
make available, to participants and bene-
ficiaries in the plan in advance of the point 
of their enrollment under the plan, a de-
scription of such limitations and restric-
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tions in a form that is easily understand-
able by such participants and beneficiaries; 
and 
‘‘(iv) the plan sponsor and the issuer 
of the coverage provides such description 
to participants and beneficiaries upon their 
enrollment under the plan at the earliest 
opportunity that other materials are pro-
vided.’’. 
(c) 
INTERNAL
REVENUE
CODE.—Section 
9802(a)(2)(B) of the Internal Revenue Code of 1986 is 
amended by inserting before the period at the end the fol-
lowing: ‘‘so long as— 
‘‘(i) such limitations and restrictions 
are explicit and clear; 
‘‘(ii) the group health plan makes 
available, to participants and beneficiaries 
in the plan in advance of the point of their 
enrollment under the plan, a description of 
such limitations and restrictions in a form 
that is easily understandable by such par-
ticipants and beneficiaries; and 
‘‘(iii) the plan provides such descrip-
tion to participants and beneficiaries upon 
their enrollment under the plan at the ear-
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liest opportunity that other materials are 
provided.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning after 1 year after the date of the enactment of this 
Act. 
Passed the House of Representatives March 31, 
2009. 
Attest: 
LORRAINE C. MILLER, 
Clerk. 
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