Notice of Pre-Existing Condition Exclusion Under Group Health Plans

Forms and Documents

Document	Type	Status	Availability
HIPAA 1210-0102ss09.doc	Supporting Statement A	Uploaded 2009-11-23	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
45340	Individual Notice of Preexisting Condition Exclusion under Group Health Plans		Modified
38419	General Notice of Pre-Existing Condition Exclusion Under Group Health Plans		Modified

ICR Details

OMB Control No: 1210-0102	ICR Reference No: 200911-1210-002
Status: Historical Active	Previous ICR Reference No: 200608-1210-002
Agency/Subagency: DOL/EBSA	Agency Tracking No:
Title: Notice of Pre-Existing Condition Exclusion Under Group Health Plans
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/31/2009
	Date Received in OIRA: 12/01/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2012	36 Months From Approved	12/31/2009
Responses	4,683,541	0	3,832,337
Time Burden (Hours)	6,661	0	5,714
Cost Burden (Dollars)	1,319,664	0	1,120,709

---

Abstract: Plans and issuers that impose preexisting condition exclusion periods must give employees eligible for coverage, as part of any enrollment application, a general notice that describes the plan’s preexisting condition exclusion, including that the plan will reduce the maximum exclusion period by the length of an employee’s prior creditable coverage. If there are no such enrollment materials, the notice must be provided as soon after a request for enrollment as is reasonably possible. The final regulation includes sample language for the general notice. See 29 CFR 2590.701-3(c). This language is likely to reduce the cost of providing the notice. Plans that use the alternative method of crediting coverage provided in the regulations must disclose their use of that method at the time of enrollment and describe how it operates. They must also explain that a participant has a right to establish prior creditable coverage through a certificate or other means and to request a certificate of prior coverage from a prior plan or issuer. Finally, plans or issuers must offer to assist the participant in obtaining a certificate from prior plans or issuers, if necessary. See 29 CFR 2590.701-4(c)(4).

---

Authorizing Statute(s): US Code: 29 USC 1181 Name of Law: Employee Retirement Income Security Act of 1974
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 49024	09/25/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 62828	12/01/2009
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
General Notice of Pre-Existing Condition Exclusion Under Group Health Plans
Individual Notice of Preexisting Condition Exclusion under Group Health Plans

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,683,541	3,832,337	0	0	851,204	0
Annual Time Burden (Hours)	6,661	5,714	0	0	947	0
Annual Cost Burden (Dollars)	1,319,664	1,120,709	0	0	198,955	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no program changes to this ICR since the last submission in 2006. The Department has updated the number of plans (respondents) based on more recent information The assumptions for costs (wage rates, postage, etc.) have also been updated, causing an increase in the annual cost burden.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/01/2009

---