Affordable Care Act Patient Protection Notice

ICR 201009-1210-005

OMB: 1210-0142

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2010-06-17
IC Document Collections
IC ID
Document
Title
Status
193285
New
ICR Details
1210-0142 201009-1210-005
Historical Active 201006-1210-003
DOL/EBSA
Affordable Care Act Patient Protection Notice
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/30/2010
Retrieve Notice of Action (NOA) 09/30/2010
  Inventory as of this Action Requested Previously Approved
12/31/2010 6 Months From Approved
6,186,404 0 0
33,000 0 0
48,000 0 0

The Patient Protection and Affordable Care Act (the Affordable Care Act) was enacted by President Obama on March 23, 2010. Section 2719A of the PHS Act, as added by the Affordable Care Act, and the Department’s interim final regulation (29 CFR 2590.715-2719A) that if a group health plan, or a health insurance issuer offering group or individual health insurance coverage, requires or provides for designation by a participant, beneficiary, or enrollee of a participating primary care provider, then the plan or issuer must permit each participant, beneficiary, or enrollee to designate any participating primary care provider who is available to accept the participant, beneficiary, or enrollee. The statute and the interim final regulations impose a requirement for the designation of a pediatrician similar to the requirement for the designation of a primary care physician. Specifically, if a plan or issuer requires or provides for the designation of a participating primary care provider for a child by a participant, beneficiary, or enrollee, the plan or issuer must permit the designation of a physician (allopathic or osteopathic) who specializes in pediatrics as the child's primary care provider if the provider participates in the network of the plan or issuer. The statute and these interim final regulations also provide that a group health plan, or a health insurance issuer may not require authorization or referral by the plan, issuer, or any person (including a primary care provider) for a female participant, beneficiary, or enrollee who seeks obstetrical or gynecological care provided by an in-network health care professional who specializes in obstetrics or gynecology. When applicable, 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, paragraph (a)(4) of the interim final regulations requires such plans and issuers to provide a notice to participants (in the individual market, primary subscribers) 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.

PL: Pub.L. 111 - 148 10101(g) Name of Law: Affordable Care Act
  
PL: Pub.L. 111 - 148 10101(g) Name of Law: Affordable Care Act

1210-AB43 Final or interim final rulemaking 75 FR 37188 06/28/2010

No

1
IC Title Form No. Form Name
Affordable Care Act Patient Protection Notice

  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 6,186,404 0 6,186,404 0 0 0
Annual Time Burden (Hours) 33,000 0 33,000 0 0 0
Annual Cost Burden (Dollars) 48,000 0 48,000 0 0 0
No
No

$0
No
No
Yes
Uncollected
No
Uncollected
Chris Cosby 202 693-8540

  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:
 
 
 
 
 
 
 
    (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.
06/18/2010


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