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DOL/EBSA | RIN: 1210-AA69 | Publication ID: Fall 1999 |
Title: Amendments to Summary Plan Description Regulations | |
Abstract: These amendments to the regulations governing the contents of summary plan descriptions (SPD) ensure that all participants in group health plans are provided, consistent with the recommendations of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, understandable information concerning their plan; provider network composition; preauthorization and utilization review procedures; whether, and under what circumstances, coverage is provided for existing and new drugs; and whether, and under what circumstances, coverage is provided for experimental drugs, devices, and procedures. These amendments repeal special rules limiting the information that must be included in summary plan descriptions with respect to certain health maintenance organizations. In addition, the amendments include provisions that update or clarify the application of certain SPD content requirements affecting both pension and welfare benefit plans. | |
Agency: Department of Labor(DOL) | Priority: Other Significant |
RIN Status: Previously published in the Unified Agenda | Agenda Stage of Rulemaking: Final Rule Stage |
Major: Yes | Unfunded Mandates: Undetermined |
CFR Citation: 29 CFR 2520.102-3 29 CFR 2520.102-5 | |
Legal Authority: 29 USC 1024 29 USC 1135 |
Legal Deadline:
None |
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Statement of Need: This regulation is necessary to improve the disclosure of group health plan benefit information, consistent with the recommendations of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, as set forth in its November 20, 1997, report. The amendments will also update the general SPD content requirements and update other relevant regulatory provisions. |
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Summary of the Legal Basis: Promulgation of this regulation is authorized by sections 101(a), 102(b), and 505 of ERISA. |
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Alternatives: Regulatory alternatives will be developed once determinations have been made with regard to the scope and nature of the amendments which are necessary to improve the disclosure of benefit information to participants and beneficiaries of group health plans under the applicable ERISA regulations. |
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Anticipated Costs and Benefits: The Department estimates that the aggregate additional costs associated with the regulation would average approximately $125 million per year for the years 2000, 2001, and 2002. However, the Department believes that the regulation would assure that participants have better access to more complete information on their benefit plans. Better information will lead both participants and plan sponsors to make more economically efficient decisions regarding benefit plans. This enhanced value and efficiency from better information constitute the benefits of the regulation. |
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Risks: Failure to issue the regulation would deprive participants, beneficiaries, and plan sponsors of the improvements in health care market efficiency which would be generated by the regulatory amendments specified therein. |
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Timetable:
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Regulatory Flexibility Analysis Required: Undetermined | Government Levels Affected: None |
Included in the Regulatory Plan: Yes | |
Agency Contact: John J. Canary Deputy Director, Office of Regulations and Interpretations Department of Labor Employee Benefits Security Administration Room N5669, 200 Constitution Avenue NW., FP Building, N5655, Washington, DC 20210 Phone:202 693-8500 |