[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1138 Introduced in Senate (IS)]


104th CONGRESS
  1st Session
                                S. 1138

To amend title XVIII of the Social Security Act to provide that certain 
 health insurance policies are not duplicative, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

               August 9 (legislative day, July 10), 1995

 Mr. Grassley introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide that certain 
 health insurance policies are not duplicative, and for other purposes.
    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 ``Medicare Consumer Protection Act of 
1995''.

SEC. 2. CERTAIN HEALTH INSURANCE POLICIES NOT DUPLICATIVE UNDER 
              MEDICARE.

    (a) In General.--Section 1882(d)(3)(A) of the Social Security Act 
(42 U.S.C. 1395ss(d)(3)(A)) is amended to read as follows:
    ``(3)(A)(i) It is unlawful for a person to sell or issue a health 
insurance policy, other than a medicare supplemental policy, to an 
individual entitled to benefits under part A or enrolled under part B 
of this title with the knowledge that such policy substantially 
duplicates health benefits to which the individual is otherwise 
entitled under this title or title XIX.
    ``(ii) Clause (i) shall not apply to--
            ``(I) a health insurance policy providing for benefits 
        which are payable to or on behalf of an individual without 
        regard to other health benefit coverage of such individual; or
            ``(II) a health insurance policy (or a rider to an 
        insurance contract which is not a health insurance policy) 
        providing benefits only for long-term care, nursing home care, 
        home health care, or community-based care, or any combination 
        thereof, that prevents duplication by coordinating against or 
        excluding items and services available or paid for under this 
        title, and such coordination or exclusion is disclosed in the 
        policy's outline of coverage.
For purposes of this subparagraph, a health insurance policy meeting 
the requirements of subclause (I) or (II) shall be deemed to be 
nonduplicative and a State may impose additional requirements with 
respect to duplication or nonduplication under clause (i) only for 
policies not meeting the requirements of such subclauses.
    ``(iii)(I) It is unlawful for a person to sell or issue a medicare 
supplemental policy to an individual entitled to benefits under part A 
or enrolled under part B of this title with the knowledge that such 
policy duplicates health benefits to which the individual is entitled 
under another medicare supplemental policy.
    ``(II) A seller (who is not the issuer) shall not be considered to 
have violated this subparagraph if the policy is sold in compliance 
with subparagraph (B) and the statement under subparagraph (B) 
indicates on its face that the sale of the policy will not duplicate 
health benefits to which the individual is otherwise entitled under 
another medicare supplemental policy.
    ``(iv) Whoever violates clause (i) or (iii) shall be fined under 
title 18, United States Code, or imprisoned not more than 5 years, or 
both, and, in addition to or in lieu of such a criminal penalty, is 
subject to a civil money penalty of not to exceed $25,000 (or $15,000 
in the case of a person other than the issuer of the policy) for each 
such prohibited act. With respect to clause (iii), this clause shall 
not apply to a seller until such date as the Secretary publishes a list 
of the standardized benefit packages that may be offered consistent 
with subsection (p).''.
    (b) Modification of Certain Disclosure Requirements.--Section 
1882(d)(3) of the Social Security Act (42 U.S.C. 1395ss(d)(3)) is 
amended--
            (1) in subparagraph (C)--
                    (A) by striking clauses (ii) and (iii);
                    (B) by striking ``(i)''; and
                    (C) by striking the comma at the end and inserting 
                a period; and
            (2) by striking subparagraph (D).
    (c) Effective Date and Other Rules.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall take effect as if 
        included in the enactment of section 4354 of the Omnibus Budget 
        Reconciliation Act of 1990 (Public Law 101-508) (hereafter 
        referred to as ``OBRA-1990'') on November 5, 1990.
            (2) Disclosure requirements.--Any amendment made by 
        subsection (a) relating to disclosure requirements for certain 
        health insurance policies shall take effect on the date that is 
        90 days after the date of the enactment of this Act.
            (3) No penalties.--No penalty shall be imposed under 
        section 1882(d)(3)(A)(i) of the Social Security Act (42 U.S.C. 
        1395ss(d)(3)(A)(i)) for any act or omission occurring after the 
        effective date of the amendments made by section 4354 of OBRA-
        90 and before the date of the enactment of this Act relating to 
        any health insurance policy that--
                    (A) meets the requirements of section 
                1882(d)(3)(A)(ii) of the Social Security Act (42 U.S.C. 
                1395ss(d)(3)(A)(ii)) (as amended by this Act), except 
                that the disclosure requirement in subclause (II) of 
                such section shall not apply; or
                    (B) was sold or issued before the effective date of 
                the amendments made by section 4354 of OBRA-90.
            (4) Limitation on legal action.--No legal action shall be 
        permitted in any Federal or State court if such legal action--
                    (A) includes any cause of action which arose, or 
                any act or omission which occurred, prior to the date 
                of the enactment of this Act;
                    (B) relates to the provisions of section 
                1882(d)(3)(A)(i) of the Social Security Act (42 U.S.C. 
                1395ss(d)(3)(A)(i)) or any policy subject to the 
                provisions thereof, with respect to the sale, issuance, 
                or renewal of any health insurance policy;
                    (C) was filed after the effective date of the 
                amendments made by section 4354 of OBRA-1990; and
                    (D) relates to any health insurance policy that--
                            (i) meets the requirements of section 
                        1882(d)(3)(A)(ii) of the Social Security Act 
                        (42 U.S.C. 1395ss(d)(3)(A)(ii)) (as amended by 
                        this Act), except that the disclosure 
                        requirement in subclause (II) of such section 
                        shall not apply; or
                            (ii) was sold or issued before the 
                        effective date of the amendments made by 
                        section 4354 of OBRA-90.
            (5) Exclusive remedies.--Notwithstanding any other 
        provision of law, the remedies provided for in section 
        1882(d)(3) of the Social Security Act (42 U.S.C. 1395ss(d)(3)), 
        as amended by this section, are the exclusive remedies 
        available with respect to the non-duplication requirements 
        described in such section.
                                 <all>