[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 1114 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                S. 1114

 To impose a limitation on lifetime aggregate limits imposed by health 
                                 plans.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 31, 1997

 Mr. Jeffords (for himself, Mr. Rockefeller, Ms. Mikulski, Mr. Inouye, 
   Mr. Daschle, Mr. Kerry, Mrs. Boxer, Mrs. Feinstein, Mr. Dodd, Mr. 
Wellstone, Mr. Harkin, and Mr. Hollings) introduced the following bill; 
 which was read twice and referred to the Committee on Labor and Human 
                               Resources

_______________________________________________________________________

                                 A BILL


 
 To impose a limitation on lifetime aggregate limits imposed by health 
                                 plans.

    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 ``Lifetime Caps Discrimination 
Prevention Act''.

SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 
              1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (as added by 
section 603(a) of the Newborns' and Mothers' Health Protection Act of 
1996 and amended by section 702(a) of the Mental Health Parity Act of 
1996) is amended by adding at the end the following new section:

``SEC. 713. LIMITATION ON LIFETIME AGGREGATE LIMITS.

    ``(a) In General.--A group health plan and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not impose an aggregate dollar lifetime limit of less 
than--
            ``(1) with respect to the first 3 plan years after the 
        effective date of this section, $5,000,000; and
            ``(2) with respect to subsequent plan years, $10,000,000;
with respect to benefits payable under the plan or coverage.
    ``(b) Small Employers.--
            ``(1) In general.--Subsection (a) shall not apply to any 
        group health plan (and group health insurance coverage offered 
        in connection with a group health plan) offered to or 
        maintained for employees of a small employer.
            ``(2) Small employer.--For purposes of paragraph (1), the 
        term `small employer' means an employer who normally employed 
        fewer than 20 employees on a typical business day during the 
        preceding calendar year and who employs fewer than 20 employees 
        on the first day of the plan year.
            ``(3) Application of certain rules in determination of 
        employer size.--For purposes of this subsection--
                    ``(A) Application of aggregation rule for 
                employers.--Rules similar to the rules under 
                subsections (b), (c), (m), and (o) of section 414 of 
                the Internal Revenue Code of 1986 shall apply for 
                purposes of treating persons as a single employer.
                    ``(B) Employers not in existence in preceding 
                year.--In the case of an employer which was not in 
                existence throughout the preceding calendar year, the 
                determination of whether such employer is a small 
                employer shall be based on the number of employees that 
                it is reasonably expected such employer will normally 
                employ on a typical business day in the current 
                calendar year.
                    ``(C) Predecessors.--Any reference in this 
                subsection to an employer shall include a reference to 
                any predecessor of such employer.
    ``(c) Definition.--In this section, the term `aggregate dollar 
lifetime limit' means, with respect to benefits under a group health 
plan or health insurance coverage, a dollar limitation on the total 
amount that may be paid with respect to such benefits under the plan or 
health insurance coverage with respect to an individual or other 
coverage unit.''.
    (b) Clerical Amendment.--The table of contents in section 1 of such 
Act, as amended by section 603 of the Newborns' and Mothers' Health 
Protection Act of 1996 and section 702 of the Mental Health Parity Act 
of 1996, is amended by inserting after the item relating to section 712 
the following new item:

``Sec. 713. Limitation on lifetime aggregate limits.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after the date that is 
2 years after the date of enactment of this Act.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT RELATING TO THE 
              GROUP MARKET.

    (a) In General.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act (as added by section 604(a) of the Newborns' and 
Mothers' Health Protection Act of 1996 and amended by section 703(a) of 
the Mental Health Parity Act of 1996) is amended by adding at the end 
the following new section:

``SEC. 2706. LIMITATION ON LIFETIME AGGREGATE LIMITS.

    ``(a) In General.--A group health plan and a health insurance 
issuer providing health insurance coverage in connection with a group 
health plan, may not impose an aggregate dollar lifetime limit of less 
than--
            ``(1) with respect to the first 3 plan years after the 
        effective date of this section, $5,000,000; and
            ``(2) with respect to subsequent plan years, $10,000,000;
with respect to benefits payable under the plan or coverage.
    ``(b) Small Employers.--
            ``(1) In general.--Subsection (a) shall not apply to any 
        group health plan (and group health insurance coverage offered 
        in connection with a group health plan) offered to or 
        maintained for employees of a small employer.
            ``(2) Small employer.--For purposes of paragraph (1), the 
        term `small employer' means an employer who normally employed 
        fewer than 20 employees on a typical business day during the 
        preceding calendar year and who employs fewer than 20 employees 
        on the first day of the plan year.
            ``(3) Application of certain rules in determination of 
        employer size.--For purposes of this subsection--
                    ``(A) Application of aggregation rule for 
                employers.--Rules similar to the rules under 
                subsections (b), (c), (m), and (o) of section 414 of 
                the Internal Revenue Code of 1986 shall apply for 
                purposes of treating persons as a single employer.
                    ``(B) Employers not in existence in preceding 
                year.--In the case of an employer which was not in 
                existence throughout the preceding calendar year, the 
                determination of whether such employer is a small 
                employer shall be based on the number of employees that 
                it is reasonably expected such employer will normally 
                employ on a typical business day in the current 
                calendar year.
                    ``(C) Predecessors.--Any reference in this 
                subsection to an employer shall include a reference to 
                any predecessor of such employer.
    ``(c) Definition.--In this section, the term `aggregate dollar 
lifetime limit' means, with respect to benefits under a group health 
plan or health insurance coverage, a dollar limitation on the total 
amount that may be paid with respect to such benefits under the plan or 
health insurance coverage with respect to an individual or other 
coverage unit.''.
    (b) Effective Date.--The amendment made by this section shall apply 
with respect to plan years beginning on or after the date that is 2 
years after the date of enactment of this Act.
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