119 
paragraphs (1) through (17)) if such sections apply. 
The description required under this paragraph may 
be combined with the notices of the type described 
in sections 711(d), 713(b), or 606(a)(1) of the Em-
ployee Retirement Income Security Act of 1974 and 
with any other notice provision that the appropriate 
Secretary determines may be combined, so long as 
such combination does not result in any reduction in 
the information that would otherwise be provided to 
the recipient. 
(19) AVAILABILITY OF ADDITIONAL INFORMA-
TION.—A statement that the information described 
in subsection (c), and instructions on obtaining such 
information (including telephone numbers and, if 
available, Internet websites), shall be made available 
upon request. 
(20) DESIGNATED
DECISIONMAKERS.—A de-
scription of the participants and beneficiaries with 
respect to whom each designated decisionmaker 
under the plan has assumed liability under section 
502(o) of the Employee Retirement Income Security 
Act of 1974 and the name and address of each such 
decisionmaker. 
(c) ADDITIONAL INFORMATION.—The informational 
materials to be provided upon the request of a participant,
120 
beneficiary, or enrollee shall include for each option avail-
able under a group health plan or health insurance cov-
erage the following: 
(1) STATUS OF PROVIDERS.—The State licen-
sure status of the plan or issuer’s participating 
health care professionals and participating health 
care facilities, and, if available, the education, train-
ing, specialty qualifications or certifications of such 
professionals. 
(2) COMPENSATION
METHODS.—A summary 
description by category of the applicable methods 
(such as capitation, fee-for-service, salary, bundled 
payments, per diem, or a combination thereof) used 
for compensating prospective or treating health care 
professionals (including primary care providers and 
specialists) and facilities in connection with the pro-
vision of health care under the plan or coverage. 
(3) PRESCRIPTION DRUGS.—Information about 
whether a specific prescription medication is in-
cluded in the formulary of the plan or issuer, if the 
plan or issuer uses a defined formulary. 
(4) UTILIZATION REVIEW ACTIVITIES.—A de-
scription of procedures used and requirements (in-
cluding circumstances, timeframes, and appeals 
rights) under any utilization review program under
121 
sections 101 and 102, including any drug formulary 
program under section 118. 
(5) EXTERNAL
APPEALS
INFORMATION.—Ag-
gregate information on the number and outcomes of 
external medical reviews, relative to the sample size 
(such as the number of covered lives) under the plan 
or under the coverage of the issuer. 
(d) MANNER OF DISCLOSURE.—The information de-
scribed in this section shall be disclosed in an accessible 
medium and format that is calculated to be understood 
by a participant or enrollee. 
(e) RULES OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to prohibit a group health plan, 
or a health insurance issuer in connection with health in-
surance coverage, from— 
(1) distributing any other additional informa-
tion determined by the plan or issuer to be impor-
tant or necessary in assisting participants, bene-
ficiaries, and enrollees in the selection of a health 
plan or health insurance coverage; and 
(2) complying with the provisions of this section 
by providing information in brochures, through the 
Internet or other electronic media, or through other 
similar means, so long as—