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New bill seeks to cover second opinions under ERISA

by on
in Employee Benefits Program,Human Resources

Rep. Susan Davis (D-Calif.) recently introduced a bill in the U.S. House of Representatives that would add mandatory coverage for second opinions on medical treatments under several laws, including the Employee Retirement Income Security Act (ERISA).

The Right to a Second Medical Opinion Act of 2009 would require employers to cover at least three sessions with an approved physician for the same cost to employees as a comparable visit with a primary participating provider.

If the bill passes, beneficiaries of group plans provided under the ERISA and individual plans through the Public Health Service Act would be able to get covered second opinions if the plan participant receives inconclusive, incomplete or ineffective information or treatment from a primary-care plan provider.

In those cases, beneficiaries would get full coverage for second opinions related to diagnoses, treatment plans, surgical procedures or medical-related therapy.

Under the bill, employers would have limited input on which health-care providers plan participants can seek out for a second opinion. Employers would be able to compel workers to seek their second opinions from in-plan physicians only if there is a qualified doctor within 50 miles of the worker’s home, and the doctor has an initial appointment available within no more than 30 days from the day the request was made.

The bill exempts health plans that are part of collective-bargaining agreements negotiated prior to the effective date of the bill.

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