Proposed Extension of Information Collection Request Submitted for Public Comment; Affordable Care Act Enrollment Opportunity Notice Relating to Dependent Coverage; Affordable Care Act Grandfathered Health Plan Disclosure and Recordkeeping Requirement; Affordable Care Act Rescission Notice; Affordable Care Act Patient Protections Notice; Affordable Care Act Enrollment Opportunity Notice-Prohibition on Lifetime Limits, 60482-60484 [2010-24674]

Agencies

• Employee Benefits Security Administration
• DEPARTMENT OF LABOR

[Federal Register Volume 75, Number 189 (Thursday, September 30, 2010)]
[Notices]
[Pages 60482-60484]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-24674]


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DEPARTMENT OF LABOR

Employee Benefits Security Administration


Proposed Extension of Information Collection Request Submitted 
for Public Comment; Affordable Care Act Enrollment Opportunity Notice 
Relating to Dependent Coverage; Affordable Care Act Grandfathered 
Health Plan Disclosure and Recordkeeping Requirement; Affordable Care 
Act Rescission Notice; Affordable Care Act Patient Protections Notice; 
Affordable Care Act Enrollment Opportunity Notice--Prohibition on 
Lifetime Limits

AGENCY: Employee Benefits Security Administration, Department of Labor.

ACTION: Notice.

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SUMMARY: The Department of Labor (the Department), in accordance with 
the Paperwork Reduction Act of 1995 (PRA 95) (44 U.S.C. 3506(c)(2)(A)), 
provides the general public and Federal agencies with an opportunity to 
comment on proposed and continuing collections of information. This 
helps the Department assess the impact of its information collection 
requirements and minimize the public's reporting burden. It also helps 
the public understand the Department's information collection 
requirements and provide the requested data in the desired format. The 
Employee Benefits Security Administration (EBSA) is soliciting comments 
on the proposed extension of the information collection provisions of 
the regulations under the Patient Protection and Affordable Care Act 
(Affordable Care Act) that are discussed below. A copy of the 
information collection requests (ICRs) may be obtained by contacting 
the office listed in the ADDRESSES section of this notice. ICRs also 
are available at reginfo.gov (https://www.reginfo.gov/public/do/PRAMain).

DATES: Written comments must be submitted to the office shown in the 
Addresses section on or before November 29, 2010.

ADDRESSES: G. Christopher Cosby, Department of Labor, Employee Benefits 
Security Administration, 200 Constitution Avenue, NW., Washington, DC 
20210, (202) 693-8410, FAX (202) 693-4745 (these are not toll-free 
numbers).

SUPPLEMENTARY INFORMATION: 
    This notice requests public comment on the Department's request for 
extension of the Office of Management and Budget's (OMB) approval of 
the information collection requests (ICRs) contained in the rules 
described below that relate to the Affordable Care Act. OMB approved 
the ICRs under the emergency procedures for review and clearance in 
accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 
U.S.C. Chapter 35) and 5 CFR 1320.13. The Department is not proposing 
any changes to the existing ICRs at this time. An agency may not 
conduct or sponsor, and a person is not required to respond to, an 
information collection unless it displays a valid OMB control number. A 
summary of the ICRs and the current burden estimates follows:
    Agency: Employee Benefits Security Administration, Department of 
Labor.
    Title: Affordable Care Act Enrollment Opportunity Notice Relating 
to Dependent Coverage.
    Type of Review: Extension without change of a currently approved 
collection of information.
    OMB Number: 1210-0139.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Respondents: 2,800,000.
    Responses: 79,573,000.
    Estimated Total Burden Hours: 411,000.
    Estimated Total Burden Cost (Operating and Maintenance): 
$1,233,500.
    Description: Section 2714 of the Public Health Service Act (PHS 
Act), as added by the Affordable Care Act, and the Department's interim 
final regulation (29 CFR 2590.715-2714) require group health plans and 
health insurance insurers offering group or individual health insurance 
coverage that makes dependent coverage available for children to 
continue to make coverage available to such children until the 
attainment of age 26. Coverage does not have to be extended to children 
of a child receiving dependent coverage. For plan years beginning on or 
after September 23, 2010 and before January 1, 2014, a grandfathered 
group health plan is not required to offer coverage to a dependent 
child under 26 who is otherwise eligible for employer-sponsored 
insurance. For plans with initial years on or after January 1, 2014, 
the plan must offer coverage regardless of whether the dependent child 
is otherwise eligible for coverage through employer sponsored 
insurance.
    Before the applicability date of PHS Act section 2714, an 
individual who was covered under a group health plan (or group health 
insurance coverage) as a dependent may have lost eligibility for 
coverage under the plan due to age before attaining age 26. Moreover, 
if a child was under age 26 when a parent first became eligible for 
coverage, but older than the age at which the plan stopped covering 
children, the child would not have become eligible for coverage. When 
the provisions of PHS Act section 2714 become applicable to the plan 
(or coverage), the plan or coverage can no longer exclude coverage for 
the individual until age 26.
    Accordingly, the interim final regulation (29 CFR 2590.715-2714(f)) 
requires plans to provide a notice of an enrollment opportunity to 
individuals whose coverage ended, or who was denied coverage (or was 
not eligible for coverage) under a group health plan or group health 
insurance coverage because, under the terms of the plan or coverage, 
the availability of dependent coverage of children ended before the 
attainment of age 26. The Affordable Care Act dependent coverage 
enrollment opportunity notice is an

[[Page 60483]]

information collection request (ICR) subject to the PRA.
    The enrollment opportunity must continue 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 2714). Coverage must begin 
not later than the first day of the first plan year (or policy year in 
the individual market) beginning on or after September 23, 2010. The 
ICR currently is scheduled to expire on November 30, 2010.
    Agency: Employee Benefits Security Administration, Department of 
Labor.
    Title: Affordable Care Act Grandfathered Health Plan Disclosure and 
Recordkeeping Requirement.
    Type of Review: Extension without change of a currently approved 
collection of information.
    OMB Number: 1210-0140.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Respondents: 2,200,000.
    Responses: 56,347,000.
    Estimated Total Burden Hours: 323,000.
    Estimated Total Burden Cost (Operating and Maintenance): $437,000.
    Description: Section 1251 of the Act provides that certain plans 
and health insurance coverage in existence as of March 23, 2010, known 
as grandfathered health plans, are not required to comply with certain 
statutory provisions in the Act. To maintain its status as a 
grandfathered health plan, the interim final regulations (29 CFR 
2590.715-1251(a)(3)) require the plan to maintain records documenting 
the terms of the plan in effect on March 23, 2010, and any other 
documents that are necessary to verify, explain or clarify status as a 
grandfathered health plan. The plan must make such records available 
for examination upon request by participants, beneficiaries, individual 
policy subscribers, or a State or Federal agency official.
    The interim final regulations (29 CFR 2590.715-1251(a)(2)) also 
require a grandfathered health plan to include a statement in any plan 
material provided to participants or beneficiaries describing the 
benefits provided under the plan or health insurance coverage, that the 
plan or coverage believes it is a grandfathered health plan within the 
meaning of section 1251 of the Affordable Care Act, that being a 
grandfathered health plan means that the plan does not include certain 
consumer protections of the Affordable Care Act, and providing contact 
information for participants to direct questions regarding which 
protections apply and which protections do not apply to a grandfathered 
health plan and what might cause a plan to change from grandfathered 
health plan status and to file complaints.
    Agency: Employee Benefits Security Administration, Department of 
Labor.
    Title: Affordable Care Act Advanced Notice of Rescission.
    Type of Review: Extension without change of a currently approved 
collection of information.
    OMB Number: 1210-0141.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Respondents: 100.
    Responses: 1,600.
    Estimated Total Burden Hours: 26.
    Estimated Total Burden Cost (Operating and Maintenance): $400.
    Description: Section 2712 of the PHS Act, as added by the 
Affordable Care Act, and the Department's interim final regulation (26 
CFR 54.9815-2712, 29 CFR 2590.715-2712, 45 CFR 147.2712) provides rules 
regarding rescissions of health coverage for group health plans and 
health insurance issuers offering group or individual health insurance 
coverage. Under the statute and these interim final regulations, a 
group health plan, or a health insurance issuer offering group or 
individual health insurance coverage, generally must not rescind 
coverage except in the case of fraud or an intentional 
misrepresentation of a material fact. This standard applies to all 
rescissions, whether in the group or individual insurance market, or 
self-insured coverage. These rules also apply regardless of any 
contestability period of the plan or issuer.
    PHS Act section 2712 adds a new advance notice requirement when 
coverage is rescinded where still permissible. Specifically, the second 
sentence in section 2712 provides that coverage may not be cancelled 
unless prior notice is provided, and then only as permitted under PHS 
Act sections 2702(c) and 2742(b). Under the interim final regulations, 
even if prior notice is provided, rescission is only permitted in cases 
of fraud or an intentional misrepresentation of a material fact as 
permitted under the cited provisions.
    The 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. The notice must be provided regardless of 
whether the rescission is of group or individual coverage; or whether, 
in the case of group coverage, the coverage is insured or self-insured, 
or the rescission applies to an entire group or only to an individual 
within the group. The ICR is schedule to expire on December 31, 2010.
    Agency: Employee Benefits Security Administration, Department of 
Labor.
    Title: Affordable Care Act Patient Protection Notice.
    Type of Review: Extension without change of a currently approved 
collection of information.
    OMB Number: 1210-0142.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Respondents: 261,680.
    Responses: 6,186,404.
    Estimated Total Burden Hours: 33,000.
    Estimated Total Burden Cost (Operating and Maintenance): $48,000.
    Description: 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 the 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.

[[Page 60484]]

    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 the 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. The ICR currently is 
scheduled to expire on December 31, 2010.
    Agency: Employee Benefits Security Administration, Department of 
Labor.
    Title: Affordable Care Act Enrollment Opportunity Notice--
Prohibition on Lifetime Limits.
    Type of Review: Extension without change of a currently approved 
collection of information.
    OMB Number: 1210-0143.
    Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
    Respondents: 315.
    Responses: 29,000.
    Estimated Total Burden Hours: 1,300.
    Estimated Total Burden Cost (Operating and Maintenance): $7,000.
    Description: Section 2711 of the PHS Act, as added by the 
Affordable Care Act and the Department's interim final regulation (29 
CFR 2590.715-2711) The Affordable Care Act dependent coverage 
enrollment opportunity notice is an information collection request 
(ICR) subject to the PRA. Before the applicability date of PHS Act 
section 2711, an individual may have met a lifetime limit under a group 
health plan or health insurance coverage and therefore lost coverage 
under the plan or coverage. When the provisions of PHS Act section 2711 
become applicable to the plan (or coverage), the plan (or coverage) can 
no longer exclude coverage for the individual by operation of the 
lifetime limit.
    Accordingly, the interim final regulations (29 CFR 2590.715-2800) 
require plans to provide a notice of an enrollment opportunity to an 
individual whose coverage ended due to reaching a lifetime limit on the 
dollar value of all benefits for any individual.
    The enrollment opportunity must continue 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 2714). Coverage must begin 
not later than the first day of the first plan year (or policy year in 
the individual market) beginning on or after September 23, 2010. The 
ICR currently is scheduled to expire on December 31, 2010.

III. Focus of Comments

    The Department of Labor (Department) is particularly interested in 
comments that:
     Evaluate whether the collections of information are 
necessary for the proper performance of the functions of the agency, 
including whether the information will have practical utility;
     Evaluate the accuracy of the agency's estimate of the 
collections of information, including the validity of the methodology 
and assumptions used;
     Enhance the quality, utility, and clarity of the 
information to be collected; and
     Minimize the burden of the collections of information on 
those who are to respond, including through the use of appropriate 
automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology, e.g., by 
permitting electronic submissions of responses.
    Comments submitted in response to this notice will be summarized 
and/or included in the ICRs for OMB approval of the extension of the 
information collection; they will also become a matter of public 
record.

    Dated: September 28, 2010.
Joseph S. Piacentini,
Director, Office of Policy and Research, Employee Benefits Security 
Administration.
[FR Doc. 2010-24674 Filed 9-29-10; 8:45 am]
BILLING CODE 4510-29-P