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DOL/EBSA RIN: 1210-AA69 Publication ID: Fall 1998 
Title: Amendments to Summary Plan Description Regulations 
Abstract: These proposed amendments to the regulations governing the contents of summary plan descriptions are intended to 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 will include the repeal of special rules limiting the information that must be included in summary plan descriptions with respect to certain health maintenance organizations. In addition, the proposed amendments will include provisions that are intended to 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: Proposed Rule Stage 
Major: Undetermined  Unfunded Mandates: Undetermined 
CFR Citation: 29 CFR 2520.102-3    29 CFR 2520.102-5   
Legal Authority: 29 USC 1024    29 USC 1135   

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.

Summary of the Legal Basis: romulgation of this regulation is authorized by sections 101(a), 102(b), and 505 of ERISA

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.

Anticipated Costs and Benefits: The Department estimates that the aggregate additional costs associated with the proposed regulation would average approximately $76 million per year for the years 1999, 2000, and 2001, although the Department believes that this estimate may be conservatively high. However, the Department believes that the proposed 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.

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.

Timetable:
Action Date FR Cite
NPRM  09/09/1998  63 FR 48376   
NPRM Comment Period End  11/09/1998    
Final Action  03/00/1999    
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