[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1201 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 1201

  To amend the Public Health Service Act to prohibit health insurance 
      discrimination with respect to victims of domestic violence.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 10, 1995

 Mr. Wyden (for himself, Mr. Schumer, and Mrs. Morella) introduced the 
following bill; which was referred to the Committee on Commerce, and in 
 addition to the Committee on Economic and Educational Opportunities, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Public Health Service Act to prohibit health insurance 
      discrimination with respect to victims of domestic violence.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Insurance Protection for Victims of 
Domestic Violence Act''.

SEC. 2. PROHIBITION OF HEALTH INSURANCE DISCRIMINATION WITH RESPECT TO 
              VICTIMS OF DOMESTIC VIOLENCE.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following new title:

  ``TITLE XXVII--PROHIBITION OF HEALTH INSURANCE DISCRIMINATION WITH 
                RESPECT TO VICTIMS OF DOMESTIC VIOLENCE

``SEC. 2701. LIMITATIONS ON UNDERWRITING.

    ``No insurer may engage in a practice that has the effect of 
denying, canceling, or not renewing health insurance coverage or health 
benefits, or establishing, increasing, or varying the premium charged 
for the coverage or benefits or excluding health coverage with respect 
to health care items or services related to treatment of a condition--
            ``(1) to an individual on the basis that the individual or 
        family member is, has been, or may be the subject of abuse, has 
        had prior injuries that resulted from abuse, or seeks, has 
        sought, or should have sought medical or psychological 
        treatment for protection against abuse, or shelter from abuse; 
        or
            ``(2) to or for a group or employer on the basis that the 
        group includes or the employer employs, or provides or 
        subsidizes insurance for, an individual described in paragraph 
        (1).

``SEC. 2702. ESTABLISHMENT OF STANDARDS.

    ``(a) Role of National Association of Insurance Commissioners.--
            ``(1) In general.--The Secretary shall request the National 
        Association of Insurance Commissioners to develop, in 
        consultation with nonprofit domestic violence victim advocacy 
        organizations, within 9 months after the date of the enactment 
        of this title, model standards that incorporate the limitations 
        on underwriting set forth in section 2701, and provide 
        procedures for enforcement for such provisions, including a 
        private right of action.
            ``(2) Review of standards.--If the Association develops 
        recommended regulations specifying the standards within the 
        period, the Secretary shall review the standards. The review 
        shall be completed within 90 days after the date the 
        regulations are developed. Unless the Secretary determines 
        within the period that such standards do not meet the 
        requirements, such standards shall serve as the standards under 
        this title, with such amendments as the Secretary determines to 
        be necessary.
    ``(b) Contingency.--If the Association does not develop the model 
regulations within the 9 month period beginning on the date of the 
enactment of this title, or the Secretary determines that the 
regulations do not specify standards that meet the requirements 
described in subsection (a), the Secretary shall specify, within 15 
months after the date of the enactment of this title, standards to 
carry out the requirements.
    ``(c) Application of Standards.--
            ``(1) In general.--Each State shall submit to the 
        Secretary, by the deadline specified in paragraph (2), a report 
        on actions the State is taking to implement and enforce the 
        standards established under this section with respect to 
        insurers and health insurance coverage offered or renewed not 
        later than such deadline.
            ``(2) Deadline for report.--Each State shall file the 
        report described in paragraph (1) not later than 1 year after 
        the date that standards are established under subsection (a) 
        or, in the event of the failure of the Association to develop 
        timely model regulations, under subsection (b).
    ``(d) Federal Role.--
            ``(1) Notice of deficiency.--If the Secretary determines 
        that a State has failed to submit a report by the deadline 
        specified by subsection (c), or finds that the State has not 
        implemented and provided adequate enforcement of the standards 
        established under subsection (a) or (b), the Secretary shall 
        notify the State and provide the State a period of 60 days in 
        which to submit the report.
            ``(2) Implementation of alternative enforcement 
        mechanism.--
                    ``(A) In general.--If, after the 60-day period, the 
                Secretary finds that such a failure has not been 
                corrected, the Secretary shall within 30 days provide 
                for a mechanism for the implementation and enforcement 
                of such standards in the State as the Secretary 
                determines to be appropriate.
                    ``(B) Civil penalty.--Under any implementation and 
                enforcement mechanism established by the Secretary 
                pursuant to this paragraph, the Secretary shall have 
                the authority to impose on an insurer a civil monetary 
                penalty in the amount of $10,000 for each day during 
                which such insurer violates the requirements described 
                in section 2701, or the standards developed under this 
                section. Liability for such penalty shall begin to 
                accrue on the 30th day after the Secretary has provided 
                such insurer with notice of its noncompliance, if the 
                insurer has failed to correct the deficiency by such 
                date.
                    ``(C) Effective period.--Any such implementation 
                and enforcement mechanism established by the Secretary 
                shall take effect with respect to insurers, and health 
                insurance coverage offered or renewed, on or after 3 
                months after the date of the Secretary's finding under 
                paragraph (1), and until the date the Secretary finds 
                that such a failure has been corrected.
            ``(3) Federal civil right of action.--
                            ``(A) In general.--Any individual aggrieved 
                        as a result of conduct prohibited by section 
                        2701 may bring a civil action in the 
                        appropriate United States district court 
                        against the insurer.
                            ``(B) Relief.--Upon proof of such conduct 
                        by a preponderance of the evidence, the insurer 
                        shall be subject to a civil penalty that may 
                        include temporary, preliminary, or permanent 
                        injunctive relief and compensatory and punitive 
                        damages, as well as the costs of suit and 
                        reasonable fees for the aggrieved individual's 
                        attorneys. With respect to compensatory 
                        damages, the aggrieved individual may elect, at 
                        any time prior to the rendering of final 
                        judgment, to recover in lieu of actual damages, 
                        an award of statutory damages in the amount of 
                        $5,000 for each violation.

``SEC. 2703. APPLICATION TO GROUP HEALTH PLANS AND ENFORCEMENT.

    ``(a) Application.--Subject to subsection (b), the prohibitions in 
section 2701 and the standards developed under section 2702 shall apply 
to group health plans providing health coverage in the same manner as 
they apply to insurers providing health insurance coverage. The penalty 
described in section 2702(d)(2)(B) may be imposed by the Secretary of 
Labor on group health plans that are not in compliance with the 
requirements of sections 2701 and 2702.
    ``(b) Substitution of Federal Officials.--For purposes of 
subsection (a), any reference in section 2702 to--
            ``(1) a State or the Secretary of Health and Human Services 
        is deemed to be a reference to the Secretary of Labor; and
            ``(2) an insurer or health insurance coverage is deemed to 
        be a reference to a group health plan and health coverage, 
        respectively.
    ``(c) Enforcement.--For purposes of part 5 of subtitle B of title I 
of the Employee Retirement Income Security Act of 1974 (29 U.S.C 1131 
et seq.) the provisions of this title insofar as they relate to group 
health plans shall be deemed to be provisions of title I of such Act 
irrespective of exclusions under section 4(b) of such Act.
    ``(d) Regulatory Authority.--With respect to the regulatory 
authority of the Secretary of Labor under this title pursuant to 
subsection (c), section 505 of the Employee Retirement Income Security 
Act of 1974 (29 U.S.C. 1135) shall apply.

``SEC. 2704. DEFINITIONS.

    ``For purposes of this title:
            ``(1) Association.--The term `Association' means the 
        National Association of Insurance Commissioners.
            ``(2) Insurer.--
                    ``(A) In general.--The term `insurer' means a 
                health benefit plan or a health care provider that 
                conducts activities related to the protection of public 
                health.
                    ``(B) Health benefit plan.--The term `health 
                benefit plan' means any public or private entity or 
                program that provides for payments for health care, 
                including--
                            ``(i) a group health plan (as defined in 
                        section 607 of the Employee Retirement Income 
                        Security Act of 1974 (29 U.S.C. 1167)) or a 
                        multiple employer welfare arrangement (as 
                        defined in section 3(40) of such Act) that 
                        provides health benefits; and
                            ``(ii) any other health insurance 
                        arrangement, including any arrangement 
                        consisting of a hospital or medical expense 
                        incurred policy or certificate, hospital or 
                        medical service plan contract, or health 
                        maintenance organization subscriber contract.
                    ``(C) Health care provider.--The term `health care 
                provider' means a provider of services (as defined in 
                section 1861(u) of the Social Security Act ( 42 U.S.C. 
                1395u)), a physician, a supplier, or any other person 
                furnishing health care, including a Federal or State 
                program that provides directly for the provision of 
                health care to beneficiaries.
            ``(3) Victim of abuse.--The term `victim of abuse' means 
        the occurrence of one or more of the following acts between 
        family or household members, current or former sexual or 
        intimate partners, or persons sharing biological parenthood--
                    ``(A) attempting to cause or intentionally, 
                knowingly, or recklessly causing bodily injury, rape, 
                or sexual abuse as such term is defined in section 2242 
                of title 18, United States Code.
                    ``(B) placing, by physical menace, another 
                individual in reasonable fear of imminent serious 
                bodily injury;
                    ``(C) infliction of false imprisonment; or
                    ``(D) physically or sexually abusing minor 
                children.''.
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