152 
vides benefits in the form of health insurance cov-
erage through a health insurance issuer, the plan 
shall be treated as meeting the following require-
ments of title I of the Patients’ Bill of Rights Act 
of 2005 with respect to such benefits and not be 
considered as failing to meet such requirements be-
cause of a failure of the issuer to meet such require-
ments so long as the plan sponsor or its representa-
tives did not cause such failure by the issuer: 
‘‘(A) Section 111 (relating to consumer 
choice option). 
‘‘(B) Section 112 (relating to choice of 
health care professional). 
‘‘(C) Section 113 (relating to access to 
emergency care). 
‘‘(D) Section 114 (relating to timely access 
to specialists). 
‘‘(E) Section 115 (relating to patient ac-
cess to obstetrical and gynecological care). 
‘‘(F) Section 116 (relating to access to pe-
diatric care). 
‘‘(G) Section 117 (relating to continuity of 
care), but only insofar as a replacement issuer 
assumes the obligation for continuity of care.
153 
‘‘(H) Section 118 (relating to access to 
needed prescription drugs). 
‘‘(I) Section 119 (relating to coverage for 
individuals participating in approved clinical 
trials). 
‘‘(J) Section 120 (relating to required cov-
erage 
for 
minimum 
hospital 
stay 
for 
mastectomies and lymph node dissections for 
the treatment of breast cancer and coverage for 
secondary consultations). 
‘‘(K) Section 134 (relating to payment of 
claims). 
‘‘(2) INFORMATION.—With respect to informa-
tion required to be provided or made available under 
section 121 of the Patients’ Bill of Rights Act of 
2005, in the case of a group health plan that pro-
vides benefits in the form of health insurance cov-
erage through a health insurance issuer, the Sec-
retary shall determine the circumstances under 
which the plan is not required to provide or make 
available the information (and is not liable for the 
issuer’s failure to provide or make available the in-
formation), if the issuer is obligated to provide and 
make available (or provides and makes available) 
such information.
154 
‘‘(3) INTERNAL APPEALS.—With respect to the 
internal appeals process required to be established 
under section 103 of such Act, in the case of a 
group health plan that provides benefits in the form 
of health insurance coverage through a health insur-
ance issuer, the Secretary shall determine the cir-
cumstances under which the plan is not required to 
provide for such process and system (and is not lia-
ble for the issuer’s failure to provide for such proc-
ess and system), if the issuer is obligated to provide 
for (and provides for) such process and system. 
‘‘(4) EXTERNAL APPEALS.—Pursuant to rules 
of the Secretary, insofar as a group health plan en-
ters into a contract with a qualified external appeal 
entity for the conduct of external appeal activities in 
accordance with section 104 of such Act, the plan 
shall be treated as meeting the requirement of such 
section and is not liable for the entity’s failure to 
meet any requirements under such section. 
‘‘(5) APPLICATION TO PROHIBITIONS.—Pursu-
ant to rules of the Secretary, if a health insurance 
issuer offers health insurance coverage in connection 
with a group health plan and takes an action in vio-
lation of any of the following sections of the Pa-
tients’ Bill of Rights Act of 2005, the group health
155 
plan shall not be liable for such violation unless the 
plan caused such violation: 
‘‘(A) Section 131 (relating to prohibition of 
interference with certain medical communica-
tions). 
‘‘(B) Section 132 (relating to prohibition 
of discrimination against providers based on li-
censure). 
‘‘(C) Section 133 (relating to prohibition 
against improper incentive arrangements). 
‘‘(D) Section 135 (relating to protection 
for patient advocacy). 
‘‘(6) CONSTRUCTION.—Nothing in this sub-
section shall be construed to affect or modify the re-
sponsibilities of the fiduciaries of a group health 
plan under part 4 of subtitle B. 
‘‘(7) TREATMENT OF SUBSTANTIALLY COMPLI-
ANT STATE LAWS.—For purposes of applying this 
subsection in connection with health insurance cov-
erage, any reference in this subsection to a require-
ment in a section or other provision in the Patients’ 
Bill of Rights Act of 2005 with respect to a health 
insurance issuer is deemed to include a reference to 
a requirement under a State law that substantially 
complies (as determined under section 152(c) of