about the plan or issuer’s decision con-
cerning a request for preapproval of a sec-
ond opinion for such participant or bene-
ficiary not later than 10 business days 
after the date on which the participant or 
beneficiary requests the preapproval. 
‘‘(ii) PROHIBITION.—A plan or issuer 
may not require preapproval of a second 
opinion if the participant or beneficiary re-
questing such approval faces an imminent 
threat to health (including the potential 
loss of life, limb, major bodily function) 
and a delay in receiving a second opinion 
would be detrimental to the participant’s 
or beneficiary’s ability to regain maximum 
function. In such cases, the provider is re-
quired to reimburse the beneficiary for the 
costs of the services and items described in 
subparagraphs (A) and (B) of subsection 
(b)(1) that are related to the second opin-
ion, minus the allowable copayments deter-
mined under paragraph (1), if the bene-
ficiary paid for such opinion from personal 
sources. 
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‘‘(d) CONSULTATION REPORT.—The plan or issuer 
may condition payment for the second opinion under sub-
section (a) on the qualified second opinion physician pro-
viding to the participant or beneficiary and to the health 
care practitioner who made the initial opinion a consulta-
tion report that includes, with respect to the medical con-
dition for which the second opinion was made, any diag-
nosis of such condition made by the qualified second opin-
ion physician and any recommended procedures, tests, or 
treatments that the qualified second opinion physician be-
lieves are appropriate. 
‘‘(e) DENIAL OF COVERAGE OR PREAPPROVAL.—If a 
plan or issuer denies coverage for a second opinion or de-
nies preapproval for a second opinion under subsection 
(c)(4), the plan or issuer shall, not later than 3 business 
days after the date of such denial— 
‘‘(1) notify the participant or beneficiary in 
writing of the reasons for the denial; 
‘‘(2) inform the participant or beneficiary of 
such participant’s or beneficiary’s right to file an ap-
peal with the plan or issuer; and 
‘‘(3) inform the participant or beneficiary of the 
process for appealing the denial. 
‘‘(f) APPEALS.— 
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‘‘(1) IN GENERAL.—The plan or issuer shall es-
tablish a process for a participant or beneficiary to 
appeal when preapproval for a second opinion or 
coverage of a second opinion is denied by the plan 
or issuer. 
‘‘(2) REPORT TO SECRETARY.—No later than 
90 days after the date of enactment of this section, 
the plan or issuer shall submit to the Secretary a re-
port describing the appeal process developed by the 
plan or issuer under paragraph (1). 
‘‘(g) TIMELINES REQUIRED.— 
‘‘(1) IN
GENERAL.—Not later than 90 days 
after the date of enactment of this section and not 
later than 30 days after the date a timeline required 
under this subsection is amended, each plan or 
issuer shall file with the Secretary a timeline for— 
‘‘(A) providing reimbursement of claims 
submitted for second opinions; and 
‘‘(B) if required by the plan or issuer, re-
sponding to requests for preapproval of second 
opinions under subsection (c)(4). 
‘‘(2) PUBLIC AVAILABILITY.—Any timeline filed 
under paragraph (1) shall be available to the public 
upon request. 
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‘‘(h) NOTICE.—The imposition of the requirement of 
this section shall be treated as a material modification in 
the terms of the plan described in section 102(a), for pur-
poses of assuring notice of such requirements under the 
plan; except that the summary description required to be 
provided under the last sentence of section 104(b)(1) with 
respect to such modification shall be provided by not later 
than 60 days after the first day of the first plan year in 
which such requirements apply. 
‘‘(i) CONSTRUCTION REGARDING ADDITIONAL OPIN-
IONS.—Nothing in this section shall be construed to pre-
vent the plan or issuer, based on its independent deter-
mination, from providing coverage to a participant or ben-
eficiary for additional medical opinions. 
‘‘(j) SERVICE PLAN CONTACTS.—The Secretary shall 
deem health care service plan contracts that provide bene-
fits to participants or beneficiaries through preferred prac-
titioner contracting arrangements to have satisfied the re-
quirements of this section if, subject to all other terms 
and conditions of the contract that apply generally to all 
other benefits, access to and coverage for second opinions 
is not limited.’’. 
(B) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 715’’. 
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(C) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 715’’. 
(D) The table of contents in section 1 of such 
Act is amended by inserting after the item relating 
to section 714 the following new item: 
‘‘Sec. 715. Coverage of second opinions.’’. 
(2) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.— 
(A) IN GENERAL.—Subpart 2 of part A of 
title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg–4 et seq.) is amended by 
adding at the end the following new section: 
‘‘SEC. 2708 COVERAGE OF SECOND OPINIONS. 
‘‘The provisions of section 715 of the Employee Re-
tirement Income Security Act of 1974, except for sub-
section (h) of such section, shall apply to group health 
plans, and health insurance issuers providing health insur-
ance coverage in connection with group health plans, as 
if included in this subpart.’’. 
(B) 
CLERICAL
AMENDMENT.—Section 
2723(c) of such Act (42 U.S.C. 300gg–23(c)) is 
amended by striking ‘‘section 2704’’ and insert-
ing ‘‘sections 2704 and 2708’’. 
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.— 
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(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
(26 U.S.C. 9811 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 9814 COVERAGE OF SECOND OPINIONS. 
‘‘The provisions of section 715 of the Employee Re-
tirement Income Security Act of 1974, except for sub-
section (h) of such section, shall apply to group health 
plans as if included in this subchapter.’’. 
(B) 
CONFORMING
AMENDMENT.—The 
table of sections for subchapter B of chapter 
100 of such Code is amended by inserting after 
the item relating to section 9813 the following 
new item: 
‘‘Sec. 9814. Coverage of second opinions.’’. 
(b) INDIVIDUAL HEALTH INSURANCE.— 
(1) IN GENERAL.—Subpart 2 of part B of title 
XXVII of the Public Health Service Act is amended 
by inserting at the end the following new section: 
‘‘SEC. 2754 COVERAGE OF SECOND OPINIONS. 
‘‘The provisions of section 2708 shall apply to health 
insurance coverage offered by a health insurance issuer 
in the individual market in the same manner as such pro-
visions apply to health insurance coverage offered by a 
health insurance issuer in connection with a group health 
plan in the small or large group market.’’. 
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(2) 
CONFORMING
AMENDMENT.—Section 
2762(b)(2) of such Act (42 U.S.C. 300gg–62(b)(2)) 
is amended by striking ‘‘section 2751’’ and inserting 
‘‘sections 2751 and 2754’’. 
(c) COORDINATION OF ADMINISTRATION.—The Sec-
retary of Labor, the Secretary of the Treasury, and the 
Secretary of Health and Human Services shall ensure, 
through the execution of an interagency memorandum of 
understanding among such Secretaries, that— 
(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same mat-
ter over which two or more such Secretaries have re-
sponsibility under the provisions of this section (and 
the amendments made thereby) are administered so 
as to have the same effect at all times; and 
(2) the enforcement of such regulations, rul-
ings, and interpretations is coordinated by such Sec-
retaries for the purposes of having a consistent en-
forcement strategy that avoids duplication of en-
forcement efforts and assigns priorities in enforce-
ment. 
(d) EFFECTIVE DATES.— 
(1) 
GROUP
HEALTH
PLANS
AND
GROUP 
HEALTH INSURANCE COVERAGE.—Subject to para-
graph (3), the amendments made by subsection (a) 
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apply with respect to group health plans for plan 
years beginning on or after January 1, 2010. 
(2) INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—The amendments made by subsection (b) 
apply with respect to health insurance coverage of-
fered, sold, issued, renewed, in effect, or operated in 
the individual market on or after January 1, 2010. 
(3) COLLECTIVE BARGAINING EXCEPTION.—In 
the case of a group health plan maintained pursuant 
to one or more collective bargaining agreements be-
tween employee representatives and one or more em-
ployers ratified before the date of enactment of this 
Act, the amendments made to subsection (a) shall 
not apply to plan years beginning before the later 
of— 
(A) the date on which the last collective 
bargaining agreement relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of the 
enactment of this Act), or 
(B) January 1, 2010. 
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement added by 
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subsection (a) shall not be treated as a termination 
of such collective bargaining agreement. 
Æ 
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