[Federal Register Volume 62, Number 211 (Friday, October 31, 1997)]
[Notices]
[Pages 59003-59007]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-28919]
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DEPARTMENT OF LABOR
Pension and Welfare Benefits Administration
Proposed Extension of Information Collection Request Submitted
for Public Comment and Recommendations; Health Insurance Portability
for Group Health Plans
ACTION: Notice.
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SUMMARY: The Department of Labor submits this notice to extend its
public information collection request (ICR) under the Health Insurance
Portability and Accountability Act of 1996
[[Page 59004]]
(HIPAA), Pub. L. 104-191, consisting of three distinct ICRs, to the
Office of Management and Budget (OMB) for review and clearance under
the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. Chapter
35). These three ICRs were first published in the Federal Register
under the Interim Rules implementing the Health Insurance Portability
Requirements for Group Health Plans on April 8, 1997. 62 FR 16920
through 16923 (April 8 Interim Rules). In the April 8 publication, the
Department submitted the group market information collection
requirements for, among other things, establishing creditable coverage,
notice of special enrollment rights, and notice of pre-existing
condition exclusions to OMB for emergency review under the Paperwork
Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. Chapter 35). OMB
approved these ICRs through December 31, 1997 under OMB Control numbers
1210-0103, 1210-0101, and 1210-0102, respectively. Subsequently, the
Department published the OMB control numbers in the Federal Register.
62 FR 36204 (July 7, 1997).
The April 8 Interim Rules contained three distinct ICRs. The ICRs
on group health plans' obligations regarding Establishing Prior
Creditable Coverage and Notice of Enrollment Rights are prescribed by
the statute.
The first ICR implements statutorily prescribed requirements
necessary to establish prior creditable coverage. This is accomplished
primarily through the issuance of certificates of prior coverage by
group health plans or by service providers that the group health plans
contract with in order to provide these documents. In addition, this
ICR permits plans to use a notice to meet their obligations in
connection with periods of coverage ending during the transition
period, October 1, 1996 through May 31, 1997, saving the respondents
both hours and cost during that period. This ICR also covers the
requests that certain plans will make regarding additional information
they require because they are using the Alternative Method of Crediting
Coverage. Finally, this ICR also includes the occasional circumstances
where a participant is unable to secure a certificate and needs to
provides some supplemental form of documentation in order to establish
prior creditable coverage.
The second ICR, Notice of Special Enrollment Rights, implements the
statutorily prescribed disclosure obligation of the plans to inform a
participant, at the time of enrollment, of the plan's special
enrollment rules.
The third ICR, Notice of Pre-Existing Condition Exclusion, concerns
the disclosure requirements on those plans that contain pre-existing
condition exclusion provisions. This ICR has two components: a notice
to all participants at the time of enrollment stating the terms of the
plan's pre-existing condition provisions, the participant's right to
demonstrate creditable coverage, and that the plan or issuer will
assist in securing a certificate if necessary; and notice by the plan
of its determination that an exclusion period applies to an individual.
1. Establishing Prior Creditable Coverage
The Department of Labor, as part of its continuing effort to reduce
paperwork and respondent burden, conducts a preclearance consultation
program to provide the general public and Federal agencies with an
opportunity to comment on proposed and/or continuing collections of
information in accordance with the Paperwork Reduction Act of 1995
(Pub. L. 104-13, 44 U.S.C. Chapter 34) and 5 CFR 1320.11. This program
helps to ensure that requested data can be provided in the desired
format, reporting burden (time and financial resources) is minimized,
collection instruments are clearly understood, and the impact of
collection requirements on respondents can be properly assessed.
Currently, the Pension and Welfare Benefits Administration is
soliciting comments concerning the proposed extension of a currently
approved collection of information, Establishing Prior Creditable
Coverage. A copy of the proposed ICR can be obtained by contacting the
employee listed below in the contact section of the notice.
DATES: Written comments must be submitted to the office listed in the
addressee section below on or before December 30, 1997. The Department
of Labor is particularly interested in comments which:
Evaluate whether the proposed collection of information is
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
burden of the proposed collection 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 collection 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., permitting
electronic submissions of responses.
ADDRESSES: Gerald B. Lindrew, Office of Policy and Research, U.S.
Department of Labor, Pension and Welfare Benefits Administration, 200
Constitution Avenue, Room N-5647, Washington, D.C. 20210. Telephone:
202-219-4782 (this is not a toll-free number). Fax: 202-219-4745.
SUPPLEMENTARY INFORMATION:
I. Background
In order to meet HIPAA's goal of improving access to and
portability of health care benefits, the statute provides that, after
the submission of evidence establishing prior creditable coverage, a
subsequent health insurance provider would be limited in the extent to
which it could use pre-existing condition exclusions to limit coverage.
This ICR covers the submission of materials sufficient to establish
prior creditable coverage.
II. Current Actions
Under 29 CFR 2590.70-5 of the April 8 Interim Rule, a group health
plan offering group health insurance coverage is obliged to provide a
written certificate of information suitable for establishing the prior
creditable coverage of a participant or beneficiary. To the extent that
a certification is not available or inadequate to prove prior
creditably coverage, paragraph (c) provides other methods for
establishing creditable coverage. During the transition period for
certification under 29 CFR 2590.710(e), plans have the option of
providing notices regarding participant's rights to certification
rather than the certification itself; plans then provide certificates
only to those participants who request them. 29 CFR 2590.701-5(a)(7)
provides special rules for establishing prior coverage of dependents,
and 29 CFR 2590.701-5(b) provides guidance on providing evidence of
coverage to those plans that use the alternative method of crediting
coverage.
The April 8 Interim Rules offer model certification and notice
forms to be used by group health plans and health insurance issuers,
containing the minimum information mandated by the statute. Based on
past experience, the staff believes that most of the materials required
to be exchanged under the certification procedure will be prepared by
contract service providers such as
[[Page 59005]]
insurance companies and third-party administrators.
Type of Review: Extension of a currently approved collection.
Agency: U.S. Department of Labor, Pension and Welfare Benefits
Administration.
Title: Establishing Prior Creditable Coverage.
OMB Number: 1210-0103.
Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions; Group Health Plans.
Frequency: On occasion.
Burden
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Total Total Average time per Burden hours
Year respondents responses response (range) (range) Cost (range)
----------------------------------------------------------------------------------------------------------------
1997......................... 2,600,000 51,799,410 3.23 min......... 502,080 $57,180,000
6.12 min......... 950,710 84,590,000
1998......................... 2,600,000 44,431,970 5.04 min......... 672,120 64,480,000
11.77 min........ 1,569,390 119,310,000
1999......................... 2,600,000 44,399,150 5.27 min......... 702,360 66,310,000
12.01 min........ 1,599,630 121,140,000
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Start up costs: It is estimated that the 15,604 plans that will
perform these functions internally (rather than use a service provider)
will incur an average cost of $5,000 per plan to revise their automated
records systems to accommodate this information for a total cost of $78
million over 10 years beginning in 1997.
Comments submitted in response to this notice will be summarized
and/or included in the request for OMB approval of the information
collection request; they will also become a matter of public record.
2. Notice of Enrollment Rights
The Department of Labor, as part of its continuing effort to reduce
paperwork and respondent burden, conducts a preclearance consultation
program to provide the general public and federal agencies with an
opportunity to comment on proposed information collection requests
(ICR) in accordance with the Paperwork Reduction Act of 1995 (Pub. L.
104-13, 44 U.S.C. Chapter 35) and 5 CFR 1320.11. This program helps to
ensure that requested data can be provided in the desired format,
reporting burden (time and financial resources) is minimized,
collection instruments are clearly understood, and the impact of
collection requirements on respondents can be properly assessed.
Currently, the Pension and Welfare Benefits Administration is
soliciting comments concerning the proposed extension of a currently
approved collection of information, Notice of Enrollment Rights.
Dates: Written comments must be submitted to the office listed in
the addressee section below on or before December 30, 1997.
The Department of Labor is particularly interested in comments
which:
Evaluate whether the proposed collection of information is
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
burden of the proposed collection 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 collection 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., permitting
electronic submissions of responses.
Addresses: Gerald B. Lindrew, Office of Policy and Research, U.S.
Department of Labor, Pension and Welfare Benefits Administration, 200
Constitution Avenue, Room N-5647, Washington, D.C. 20210. Telephone:
202-219-4782 (this is not a toll-free number). Fax: 202-219-4745.
I. Background
In order to improve participants' understanding of their rights
under an employer's welfare benefit plan, the statute provides that, a
participant be provided with a description of a plan's special
enrollment rules on or before the time when a participant is offered
the opportunity to enroll in a group health plan.
II. Current Actions
Under 29 CFR 2590.701-6 of the April 8 Interim Rules, a group
health plan offering group health insurance coverage is obligated to
provide a description of the plans' special enrollment rules. The
special enrollment rules generally apply in circumstances when the
participant initially declined to enroll in the plan, and subsequently
would like to have coverage.
The April 8 Interim Rules offer a model form to be used by group
health plans and health insurance issuers, containing the minimum
information mandated by the statute. Based on past experience, the
staff believes that most of the materials required to be supplied under
this ICR will be prepared by contract service providers such as
insurance companies and third-party administrators.
Type of Review: Extension of a currently approved collection.
Agency: U.S. Department of Labor, Pension and Welfare Benefits
Administration.
Title: Notice of Enrollment Rights.
OMB Number: 1210-0101.
Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions; Group Health Plans.
Frequency: On occasion.
[[Page 59006]]
Burden
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Total
Year respondents Total Average time per Burden hours Cost
(000) responses response
----------------------------------------------------------------------------------------------------------------
1997......................... 2,600,000 499,080 .50 min.......... 750 100,000
1998......................... 2,600,000 7,622,010 .50 min.......... 11,430 1,460,000
1999......................... 2,000,000 8,959,380 .50 min.......... 13,440 1,720,000
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Comments submitted in response to this notice will be summarized
and/or included in the request for OMB approval of the information
collection request; they will also become a matter of public record.
3. Notice of Pre-Existing Condition Exclusion
The Department of Labor, as part of its continuing effort to reduce
paperwork and respondent burden, conducts a preclearance consultation
program to provide the general public and federal agencies with an
opportunity to comment on proposed information collection requests
(ICR) in accordance with the Paperwork Reduction Act of 1995 (Pub. L.
104-13, 44 U.S.C. Chapter 35) and 5 CFR 1320.11. This program helps to
ensure that requested data can be provided in the desired format,
reporting burden (time and financial resources) is minimized,
collection instruments are clearly understood, and the impact of
collection requirements on respondents can be properly assessed.
Currently, the Pension and Welfare Benefits Administration is
soliciting comments concerning the proposed extension of a currently
approved collection of information, Notice of Pre-Existing Condition
Exclusion. A copy of the proposed ICR can be obtained by contacting the
employee listed below in the contact section of the notice.
Dates: Written comments must be submitted to the office listed in
the addressee section below on or before December 30, 1997.
The Department of Labor is particularly interested in comment
which:
Evaluate whether the proposed collection of information is
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
burden of the proposed collection of information, including the
validity of the methodology and assumptions used;
Enhance of quality, utility, and clarity of the
information to be collected; and
Minimize the burden of the collection 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., permitting
electronic submissions of responses.
Addresses: Gerald B. Lindrew, Office of Policy and Research, U.S.
Department of Labor, Pension and Welfare Benefits Administration, 200
Constitution Avenue, Room N-5647, Washington, DC 20210. Telephone: 202-
219-4782 (this is not a tool-free number). Fax: 202-219-4745.
I. Background
In order to meet HIPAA's goal of improving portability of health
care coverage, participants need to understand their rights to show
prior creditable coverage when entering a group health plan that
contains pre-existing condition exclusion provisions. In addition,
participants entering plans that use the alternative method of
crediting coverage also need to be informed of the plan's provisions.
Therefore, the Department has determined that plans that contain these
provisions must disclose that fact to new participants, as well as
inform individual participants of the extent to which a pre-existing
condition exclusion applies to them.
II. Current Actions
29 CFR 2590.701-3(c) requires that a group health plan or health
insurance issuer offering group health insurance under the plan may not
impose any pre-existing condition exclusions on a participant unless
the participant has been notified in writing that the plan contains
pre-existing condition exclusions, that a participant has the right to
demonstrate any period of prior creditable coverage, and that the plan
or issuer will assist the participant in obtaining a certificate of
prior coverage from any prior plan or issuer, if necessary. 20 CFR
2590.701-4(c)(4) requires that plans that use the alternative method of
crediting coverage disclose their method at the time of enrollment in
the plan. No additional cost of preparing or distributing this
information has been included in this analysis because plans would only
pursue this option if it were, on net, less costly than the standard
method.
In addition, 29 CFR 2590.701-5(d)(2) requires that before a plan or
issuer imposes a pre-existing condition exclusion on a particular
participant, it must first disclose that determination in writing,
including the basis for the decision, and an explanation of any appeal
procedure established by the plan or issuer.
Type of Review: Extension of a currently approved collection.
Agency: U.S. Department of Labor, Pension and Welfare Benefits
Administration.
Title: Notice of Pre-Existing Exclusion Provisions.
Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions; Group Health Plans.
Frequency: On occasion.
Burden
----------------------------------------------------------------------------------------------------------------
Total Total Average time per
Cite/reference respondents responses response Burden hours Cost
----------------------------------------------------------------------------------------------------------------
Notice at time of Enrollment:
1997..................... 1,261,450 500,800 0.70 min......... 2,470 $180,000
1998..................... 1,261,450 7,626,880 0.54 min......... 16,300 1,700,000
1999..................... 1,261,450 8,959,700 0.50 min......... 13,750 1,730,000
Notice of Pre-Existing
Condition causing lack of
coverage:
1997..................... 1,261,450 57,000 2.27 min......... 1,800 100,000
[[Page 59007]]
1998..................... 1,261,450 862,830 0.84 min......... 6,160 410,000
1999..................... 1,261,450 1,008,810 0.52 min......... 1,830 210,000
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Comments submitted in response to this notice will be summarized
and/or included in the request for OMB approval of the ICRs; they will
also become a matter of public record.
Dated: October 28, 1997.
Gerald B. Lindrew,
Deputy Director, Pension and Welfare Benefits Administration, Office of
Policy and Research.
[FR Doc. 97-28919 Filed 10-30-97; 8:45 am]
BILLING CODE 4510-29-M
