109 
the diagnosis and treatment of cancer shall ensure 
that full coverage is provided for secondary consulta-
tions by specialists in the appropriate medical fields 
(including pathology, radiology, and oncology) to 
confirm or refute 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 
consultation are not sufficiently available from spe-
cialists operating under the plan or coverage with re-
spect to whose services coverage is otherwise pro-
vided under such plan or by such issuer, such plan 
or issuer shall ensure 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 addi-
tional cost to the individual beyond that which the 
individual would have paid if the specialist was par-
ticipating in the network of the plan or issuer. 
(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.
110 
(d) PROHIBITION ON PENALTIES OR INCENTIVES.— 
A group health plan, and a health insurance issuer pro-
viding health insurance coverage, may not— 
(1) penalize or otherwise reduce or limit the re-
imbursement of a provider or specialist because the 
provider or specialist provided care to a participant, 
beneficiary, or enrollee in accordance with this sec-
tion; 
(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; or 
(3) provide financial or other incentives to a 
physician or specialist to induce the physician or 
specialist to refrain from referring a participant, 
beneficiary, or enrollee for a secondary consultation 
that would otherwise be covered by the plan or cov-
erage involved under subsection (c). 
Subtitle C—Access to Information 
SEC. 121. PATIENT ACCESS TO INFORMATION. 
(a) REQUIREMENT.— 
(1) DISCLOSURE.—
111 
(A) IN GENERAL.—A group health plan, 
and a health insurance issuer that provides cov-
erage in connection with health insurance cov-
erage, shall provide for the disclosure to partici-
pants, beneficiaries, and enrollees— 
(i) of the information described in 
subsection (b) at the time of the initial en-
rollment of the participant, beneficiary, or 
enrollee under the plan or coverage; 
(ii) of such information on an annual 
basis— 
(I) in conjunction with the elec-
tion period of the plan or coverage if 
the plan or coverage has such an elec-
tion period; or 
(II) in the case of a plan or cov-
erage that does not have an election 
period, in conjunction with the begin-
ning of the plan or coverage year; and 
(iii) of information relating to any 
material reduction to the benefits or infor-
mation described in such subsection or 
subsection (c), in the form of a notice pro-
vided not later than 30 days before the 
date on which the reduction takes effect.