[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2874 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 2874

   To provide for prompt disclosure to insured individuals of their 
 medical condition after undergoing medical examinations necessary to 
                    qualify for insurance coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 7, 1997

Mr. Ackerman (for himself, Mr. Coburn, Mr. Abercrombie, Mr. Bartlett of 
  Maryland, Mr. Becerra, Mr. Bishop, Mr. Bono, Mr. Brown of Ohio, Mr. 
Burton of Indiana, Mr. Clyburn, Mr. Cook, Mr. Cramer, Mr. DeFazio, Mr. 
 Dellums, Mr. Deutsch, Ms. Eshoo, Mr. Farr of California, Mr. Fazio of 
 California, Mr. Foglietta, Mr. Ford, Mr. Frank of Massachusetts, Mr. 
 Frost, Mr. Graham, Mr. Green, Mr. Gutierrez, Mr. Hefner, Mr. Hinchey, 
   Mr. Hoyer, Mr. Jefferson, Ms. Eddie Bernice Johnson of Texas, Ms. 
 Kaptur, Mrs. Kelly, Mr. Kennedy of Rhode Island, Ms. Kilpatrick, Mr. 
 Kind, Mr. Kucinich, Mr. LaFalce, Mr. Lampson, Mr. Lazio of New York, 
   Mr. Lewis of Georgia, Mrs. Lowey, Mrs. McCarthy of New York, Ms. 
 McKinney, Mr. McNulty, Mrs. Meek of Florida, Mr. Menendez, Mr. Miller 
   of California, Mr. Nadler, Mr. Ortiz, Mr. Owens, Mr. Pallone, Mr. 
 Paxon, Ms. Rivers, Mr. Rodriguez, Ms. Ros-Lehtinen, Mr. Rothman, Mr. 
    Sanders, Mr. Sawyer, Mr. Schumer, Mr. Serrano, Mr. Sherman, Ms. 
  Slaughter, Mr. Tanner, Mr. Taylor of Mississippi, Mr. Thompson, Mr. 
     Turner, Ms. Velazquez, Mr. Walsh, Mr. Waxman, and Mr. Wexler) 
 introduced the following bill; which was referred to the Committee on 
    Commerce, and in addition to the Committee on Education and the 
 Workforce, 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 provide for prompt disclosure to insured individuals of their 
 medical condition after undergoing medical examinations necessary to 
                    qualify for insurance coverage.

    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 Disclosure Act of 1997''.

SEC. 2. DEFINITIONS.

    As used in this Act:
            (1) Insurer.--The term ``insurer'' means any person, 
        reciprocal exchange, interinsurer, Lloyds insurer, fraternal 
        benefit society, or other legal entity engaged in the business 
        of insurance, including agents, brokers, adjusters, and third 
        party administrators. The term also includes health benefit 
        plans, health carriers, and life, disability, and property and 
        casualty insurers.
            (2) Health benefit plan.--The term ``health benefit plan'' 
        means any public or private entity or program that provides for 
        payments for health care, including--
                    (A) a group health plan (as defined in section 
                2791(a)(1) of the Public Health Service Act (42 U.S.C. 
                300gg-91(a)(1)), section 733(a)(1) of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1191b(a)(1)), or section 5000(b)(1) of the Internal 
                Revenue Code of 1986));
                    (B) a multiple employer welfare arrangement (as 
                defined in section 3(40) of the Employee Retirement 
                Income Security Act (29 U.S.C. 1002(40))) that provides 
                benefits consisting of medical care (as defined in 
                section 733(a)(2) of such Act (29 U.S.C. 1191b(a)(2))), 
                including items and services paid for as medical care;
                    (C) 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;
                    (D) workers' compensation or similar insurance to 
                the extent that it relates to workers' compensation 
                medical benefits (as defined in regulations of the 
                Secretary);
                    (E) automobile medical insurance to the extent that 
                it relates to medical benefits (as defined in 
                regulations of the Secretary); and
                    (F) any other insurance providing for enrollees 
                medical benefits (as defined in regulations of the 
                Secretary) in the event of sickness, accident, 
                disability, death, or unemployment.
            (3) Health carrier.--The term ``health carrier'' means a 
        person that contracts or offers to contract on a risk-assuming 
        basis to provide, deliver, arrange for, pay for, or reimburse 
        any of the cost of health care services, including a sickness 
        and accident insurance company, a health maintenance 
        organization, a nonprofit hospital and health service 
        corporation, or any other entity providing a plan of health 
        insurance, health benefits, or health services.
            (4) Policy.--The term ``policy'' means a contract of 
        insurance, certificate, indemnity, suretyship, or annuity 
        issued, proposed for issuance, or intended for issuance by an 
        insurer, including endorsements or riders to an insurance 
        policy or contract.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 3. ACCESS BY EXAMINED INDIVIDUAL TO RESULTS OF MEDICAL 
              EXAMINATIONS.

    An insurer shall take such actions as are necessary to ensure that, 
in any case in which--
            (1) a medical examination of an individual is required for 
        initial or continued enrollment under a policy issued by the 
        insurer, and
            (2) such medical examination is conducted by a person who 
        is in the employ of the insurer or whose services are procured 
        otherwise by the insurer,
such individual (or the individual's legal guardian) is provided all 
medical information obtained from such examination at the same time 
that such information is made available to the insurer and is 
encouraged to make such information available to such individual's own 
physician.

SEC. 4. ENFORCEMENT.

    (a) Applicability of Certain Public Health Service Act 
Provisions.--
            (1) In general.--For purposes of sections 2722 and 2723 of 
        the Public Health Service Act (42 U.S.C. 300gg-22, 300gg-23), 
        the provisions of section 3 shall be deemed provisions of part 
        A of title XXVII of such Act. For purposes of sections 2761 and 
        2762 of such Act (42 U.S.C. 300gg-45, 300gg-46), the provisions 
        of section 3 shall be deemed provisions of part B of such title 
        XXVII.
            (2) Rules of construction.--In applying such sections 2722, 
        2723, 2761 and 2762, and section 2791(d) of such Act (42 U.S.C. 
        300gg-91(d)) pursuant to paragraph (1)--
                    (A) any reference to a ``health insurance issuer'' 
                shall be deemed a reference to an insurer (as defined 
                in section 2(1)));
                    (B) any reference to ``health insurance coverage'' 
                (including any such coverage offered in connection with 
                a group health plan) shall be deemed a reference to a 
                policy (as defined in section 2(4));
                    (C) any reference to a ``group health plan'' shall 
                be deemed a reference to a group insurance plan (as 
                defined in section 111(b)(1) of the Employee Retirement 
                Income Security Act of 1974, and subject to the same 
                rules as apply with respect to group health plans under 
                section 2721(a) of the Public Health Service Act (42 
                U.S.C. 300gg-21(a))); and
                    (D) any reference to part A or part B of title 
                XXVII of such Act shall be deemed a reference to 
                sections 2 through 6 of this Act.
    (b) Private Cause of Action.--
            (1) In general.--An individual who believes that he or she 
        has been adversely affected by an act or practice of an insurer 
        in violation of section 3 may maintain an action against the 
        insurer in a Federal or State court of original jurisdiction. 
        Upon proof of such conduct by a preponderance of the evidence, 
        the court may award appropriate relief, including temporary, 
        preliminary, and permanent injunctive relief and compensatory 
        and punitive damages, as well as the costs of suit and 
        reasonable fees for the aggrieved individual's attorneys and 
        expert witnesses. 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 $10,000 
        for each violation. It shall be the duty of the Federal courts 
        to advance on the docket and to expedite to the greatest 
        possible extent the disposition of any action for temporary or 
        preliminary injunctive relief considered under this paragraph.
            (2) Additional provisions relating to jurisdiction, venue, 
        attorney's fees, etc.--
                    (A) In general.--Subject to subparagraph (B), 
                subsections (d), (e), (f), (g), (h), and (j) of section 
                502 of the Employee Retirement Income Security Act of 
                1974 (29 U.S.C. 1132(d), (e), (f), (g), (h), and (j)) 
                shall apply with respect to a cause of action under 
                paragraph (1) in the same manner and to the same extent 
                as such subsections apply with respect to a cause of 
                action under section 502(a)(1)(B) of such Act (29 
                U.S.C. 1132(a)(1)(B)).
                    (B) Rules of construction.--In applying such 
                subsections pursuant to subparagraph (A)--
                            (i) any reference to a ``participant'' or 
                        ``beneficiary'' shall be deemed a reference to 
                        the aggrieved individual referred to in 
                        paragraph (1);
                            (ii) any reference to an ``employee benefit 
                        plan'' shall be deemed a reference to an 
                        insurer (as defined in section (2)(A));
                            (iii) any reference to the Secretary of 
                        Labor or the Secretary of the Treasury shall be 
                        deemed a reference to the Secretary of Health 
                        and Human Services; and
                            (iv) any reference to title I of such Act 
                        shall be deemed a reference to sections 2 
                        through 6 of this Act.

SEC. 5. EFFECT ON STATE LAW.

    (a) In General.--Section 3 supersedes any provision of State law 
which is inconsistent with any provision of such section, in terms of 
providing less protection to individuals than is provided by such 
section, but only to the extent of such inconsistency. Nothing in 
section 3 shall be construed to--
            (1) alter or relieve any insurer from the obligation to 
        comply with any State law with respect to insurers, policies, 
        and health benefit plans, except to the extent that such law is 
        inconsistent with any provision of section 3, or
            (2) preclude a State from enacting any law or regulation 
        that affords a greater level or broader range of protections to 
individuals under policies or health benefit plans.
    (b) Definitions.--For purposes of this section, the terms ``State'' 
and ``State law'' have the meanings provided such terms under section 
514(c) of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1144(c)).

SEC. 6. REGULATIONS.

    The Secretary (in consultation with the Secretary of Labor) shall 
prescribe regulations to carry out the provisions of sections 2 through 
5.

SEC. 7. ERISA REQUIREMENTS FOR DISCLOSURE BY GROUP INSURANCE PLANS TO 
              PARTICIPANTS AND BENEFICIARIES OF THEIR MEDICAL CONDITION 
              LEARNED IN THE COURSE OF MEDICAL EXAMINATIONS REQUIRED 
              FOR COVERAGE UNDER SUCH PLANS.

    (a) In General.--Part 1 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 is amended--
            (1) by redesignating section 111 (29 U.S.C. 1031) as 
        section 112; and
            (2) by inserting after section 110 (29 U.S.C. 1030) the 
        following new section:

 ``disclosure to participants and beneficiaries of results of medical 
            examinations conducted by group insurance plans

    ``Sec. 111. (a) In General.--A group insurance plan, and any 
insurer offering a policy in connection with such plan, shall take such 
actions as are necessary to ensure that, in any case in which--
            ``(1) a medical examination of a participant or beneficiary 
        is required for initial or continued eligibility for benefits, 
        and
            ``(2) such medical examination is conducted by a person who 
        is in the employ of the plan or the insurer or whose services 
        are procured otherwise by the plan or the insurer,
such participant or beneficiary (or his or her legal guardian) is 
provided all medical information obtained from such examination at the 
same time that such information is made available to the plan or 
insurer and is encouraged to make such information available to his or 
her own physician.
    ``(b) Definitions.--For purposes of this section--
            ``(1) Group insurance plan.--The term `group insurance 
        plan' means an employee welfare benefit plan established and 
        maintained for the purpose of providing for its participants or 
        their beneficiaries, through the purchase of insurance or 
        otherwise, medical, surgical, or hospital care or benefits, or 
        benefits in the event of sickness, accident, disability, death, 
        or unemployment.
            ``(2) Policy.--The term ``policy'' means a contract of 
        insurance, certificate, indemnity, suretyship, or annuity, 
        including endorsements or riders to an insurance policy or 
        contract.
    ``(c) Effect on State Law.--This section supersedes any provision 
of State law which is inconsistent with any provision of this section, 
in terms of providing less protection to participants and beneficiaries 
than is provided by this section, but only to the extent of such 
inconsistency. Nothing in this section shall be construed to--
            ``(1) alter or relieve any plan administrator from the 
        obligation to comply with the laws of any State with respect to 
        group insurance plans, except to the extent that such laws are 
        inconsistent with any provision of this section, or
            ``(2) preclude a State from enacting any law or regulation 
        that affords a greater level or broader range of protections to 
        participants and beneficiaries under group insurance plans.
    ``(d) Expedited Consideration.--It shall be the duty of the Federal 
courts to advance on the docket and to expedite to the greatest 
possible extent the disposition of any action under section 502 for 
temporary or preliminary injunctive relief from violations of this 
section.
    ``(e) Regulations.--The Secretary (in consultation with the 
Secretary of Health and Human Services) shall prescribe regulations to 
carry out the provisions of this section.''.
    (b) Penalties at $100 a Day for Failure to Disclose.--Section 
502(c)(1)(A) of such Act (29 U.S.C. 1132(c)(1)(A)) is amended by 
striking ``or section 101(e)(1)'' and inserting ``, section 101(e)(1), 
or section 111(a)''.
    (c) Conforming Amendment.--The table of contents in section 1 is 
amended by striking the item relating to section 111 and inserting the 
following new items:

``Sec. 111. Disclosure to participants and beneficiaries of results of 
                            medical examinations conducted by group 
                            insurance plans.
``Sec. 112. Repeal and effective date.''.

SEC. 8. EFFECTIVE DATE.

    Sections 2, 3, 4, 5, and 6 shall apply with respect to any action 
taken on or after the date of the enactment of this Act. The amendments 
made by section 7 shall apply with respect to plan years beginning on 
or after such date.
                                 <all>