Yesterday, the House passed (422 Ayes, 3 Nays) “H.R. 1253, the Health Insurance Restrictions and Limitations Clarification Act of 2009” which amends ERISA, the Code, and the Public Health Service 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 participants and beneficiaries under such plans in a form that is “clear and explicit.”
To get a good understanding of what this bill is supposed to accomplish, I refer you to the floor speech given by Representative Michael Burgess [R-TX]:
Mr. Speaker, in January 2001, the Department of Labor, the Internal Revenue Service, and the Health Care Finance Administration issued a rule in accordance with the Health Insurance Portability and Accountability Act, better known as HIPAA, of 1996 that was designed to guard against discrimination in coverage in the group health market. While addressing the issue of discrimination based upon participation in certain activities, these rules allowed continued discrimination in the form of nonpayment based upon the source of the injury.So, in other words, you could have an employer-sponsored health insurance, which many of us do, have your premiums deducted from your paycheck, and yet be responsible for paying your own medical treatment if you were harmed. Trip and fall at home, no problem. Trip and fall while skiing on vacation with the family, and you get the bill. This is simply unfair.
People are led to believe that care for a broken arm, for example, is the same regardless of how the injury happened, but in fact that is not the case.
The lack of clarity underlying these exclusions has created a confusing situation for individuals that may ride motorcycles, horses, snowmobiles, or participate in other activities that could result in an injury. Millions of American enjoy these activities safely every year within the framework of State laws and utilizing proper safety precautions. The bill we are voting on today will take away the ambiguity and make certain that people are aware of any such restrictions in their coverage.
Again, this is not a bill that would require anything new to be done other than people be told up front and in plain language if there are limitations on their health care policy.
We are going to stand up and shine the light on these exclusions so that Americans will not be caught off guard by exclusions buried deep within an insurance plan.
The legislation would retain HIPAA’s provision of allowing group health plans to establish limitations or restrictions on the amount, level, extent, or nature of benefits or coverage provided, but would require that any limitations and restrictions:
(1) Be disclosed in writing to the plan sponsor in advance of the point of sale to the plan; and
(2) Be disclosed by the plan sponsor to participants and beneficiaries in a form “that is easily understandable” by such participants and beneficiaries.
The legislation also provides that the plan sponsor and the issuer of the coverage must provide such description to participants and beneficiaries “upon their enrollment under the plan at the earliest opportunity that other materials are provided.”