Enrollment Opportunity Notice Relating to Lifetime Limits; Required Notice of Rescission of Coverage; and Disclosure Requirements for Patient Protection under the Affordable Care Act (P.L. 111-148)
ICR 201006-0938-009
OMB: 0938-1094
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1094 can be found here:
Enrollment Opportunity Notice
Relating to Lifetime Limits; Required Notice of Rescission of
Coverage; and Disclosure Requirements for Patient Protection under
the Affordable Care Act (P.L. 111-148)
New
collection (Request for a new OMB Control Number)
Provisions 2711, 2712, and 2719a of
the Affordable Care Act contain enrollment opportunity, rescission
notice, and patient protection disclosure requirements that are
subject to the Paperwork Reduction Act of 1995. The enrollment
opportunity notice will be used by health plans to notify certain
individuals of their right to re-enroll in their plan. The affected
individuals are those whose coverage ended due to reaching a
lifetime limit on the dollar value of all benefits for any
individual. The rescission notice will be used by health plans to
provide advance notice to certain individuals that their coverage
may be rescinded. The affected individuals are those who are at
risk of rescission on their health insurance coverage. The patient
protection notification will be used by health plans to inform
certain individuals of their right to choose a primary care
provider or pediatrician and to use obstetrical/gynecological
services without prior authorization.
The Patient Protection
and Affordable Care Act (the Affordable Care Act) was enacted by
President Obama on March 23, 2010. Section 2711 of the PHS Act
amended by the Affordable Care Act requires a plan or issuer to
provide an individual whose coverage ended due to reaching a
lifetime limit on the dollar value of all benefits with an
opportunity to enroll (including notice of an opportunity to
enroll) that continues for at least 30 days, regardless of whether
the plan or coverage offers an open enrollment period and
regardless of when any open enrollment period might otherwise
occur. This enrollment opportunity must be presented not later than
the first day of the first plan year (or, in the individual market,
policy year) beginning on or after September 23, 2010 (which is the
applicability date of PHS Act sections 2711). Coverage must not
begin later than the first day of the first plan year (or policy
year in the individual market) beginning on or after September 23,
2010. Section 2712 of the PHS Act amended by the Affordable Care
Act prohibits group health plans and health insurance issuers that
offer group or individual health insurance coverage generally from
rescinding coverage under the plan, policy, certificate, or
contract of insurance from the individual covered under the plan or
coverage unless the individual (or a person seeking coverage on
behalf of the individual) performs an act, practice, or omission
that constitutes fraud, or unless the individual makes an
intentional misrepresentation of material fact, as prohibited by
the terms of the plan or coverage. These interim final regulations
provide that a group health plan or a health insurance issuer
offering group health insurance coverage must provide at least 30
days advance notice to an individual before coverage may be
rescinded. Section 2719A of the PHS Act amended by the Affordable
Care Act imposes, with respect to a group health plan, or group or
individual health insurance coverage, a set of three requirements
relating to the choice of a health care professionals The
Departments believe it is important that individuals enrolled in a
plan or health insurance coverage know of their rights to (1)
choose a primary care provider or a pediatrician when a plan or
issuer requires participants or subscribers to designate a primary
care physician; or (2) obtain obstetrical or gynecological care
without prior authorization. Accordingly, these interim final
regulations require such plans and issuers to provide a notice to
participants (in the individual market, primary subscriber) of
these rights when applicable. Model language is provided in these
interim final regulations. The notice must be provided whenever the
plan or issuer provides a participant with a summary plan
description or other similar description of benefits under the plan
or health insurance coverage, or in the individual market, provides
a primary subscriber with a policy, certificate, or contract of
health insurance. Due to the urgency and short time frames
associated with these provisions, HHS does not have sufficient time
to allow for the usual comment timeframe allotted in the PRA
process.
PL: Pub.L. 111 - 148 2711 Name of Law: No
lifetime or annual limits
PL: Pub.L. 111 - 148 2712 Name of Law: Prohibition on
rescissions
PL: Pub.L. 111 - 148 2719A Name of Law: Patient
Protections
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:
(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;
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.
Section 2719A - Patient Protections