Core Provisions: This legislation would amend the provisions of the Employee Retirement Income Security Act, Public Health Service Act, and Internal Revenue Code that permit group health plans to establish limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for participants and beneficiaries of the plan. The new language would clarify that such limitations must be explicit and clear and must be disclosed to the plan sponsor before the point of sale to the plan. The plan sponsor and issuer of the coverage would be required to make available to participants and beneficiaries prior to their enrollment and upon their enrollment, a description of such limitations and restrictions in an easily understandable form.
Status: H.R. 1253 was introduced by Rep. Burgess (R-TX) on March 3, 2009 and it passed the House on March 31, 2009. The bill now moves to the Senate for consideration. The House passed identical legislation in the 110th Congress.