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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 17 / 83





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language that must be used by plan administrators to satisfy the notice requirement for group

health plans subject to the PHS Act.

In the individual market. Section 2751(a) of the PHS Act applies the NMHPA

requirements to health insurance issuers in the individual market. Section 2751(b) states that a

health insurance issuer subject to the individual market provisions of the PHS Act “shall comply

with the notice requirement under section 711(d) of [ERISA] with respect to [the NMHPA

requirements] as if such section applied to such issuer and such issuer were a group health plan.”

Issuers in the individual market are not subject to any federal requirements comparable to

disclosure of a “summary plan description” under ERISA, although they may be subject to similar

State law requirements. In addition, the concept of a “plan year” does not apply in the individual

market, and the effective date of the NMHPA requirements is not tied to a plan year.

Accordingly, the requirements of these interim rules apply to health insurance coverage “offered,

sold, issued, renewed, in effect, or operated” in the individual market on or after the effective date

of these interim rules.10

These interim rules interpret section 2751(b) of the PHS Act to require that issuers of

individual health insurance coverage that includes benefits for hospital lengths of stay in

connection with childbirth must include a statement in the insurance contract describing the

NMHPA requirements, and, not later than 60 days after the effective date of the interim rules,

provide covered individuals with a rider or equivalent document that gives notice of the NMHPA

requirements. The interim rules set forth the language that must be used in an insurance contract

10 Although the specific requirements of these interim rules therefore apply on or after January 1, 1999, the underlying statutory requirement went into effect January 1, 1998, the effective date of NMHPA.


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