Proposed Extension of Information Collection Request Submitted for Public Comment and Recommendations; Health Insurance Portability for Group Health Plans

Federal RegisterOct 31, 1997

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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