[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2321 Introduced in House (IH)]






108th CONGRESS
  1st Session
                                H. R. 2321

  To promote and facilitate expansion of coverage under group health 
                     plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 4, 2003

Mr. Andrews (for himself and Mr. Payne) introduced the following bill; 
which was referred to the Committee on Education and the Workforce, and 
  in addition to the Committee on Ways and Means, 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 promote and facilitate expansion of coverage under group health 
                     plans, 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 ``Group Health Plan Coverage Expansion 
Act of 2003''.

SEC. 2. PROGRAM TO PROMOTE AND FACILITATE EXPANSION OF COVERAGE UNDER 
              GROUP HEALTH PLANS.

    (a) In General.--Part 5 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 is amended by adding after 
section 518 (29 U.S.C. 1148) the following new section:

``SEC. 519. PROMOTION AND FACILITATION OF COVERAGE UNDER GROUP HEALTH 
              PLANS.

    ``(a) In General.--The Secretary shall establish by regulation a 
program--
            ``(1) to promote and facilitate the availability to 
        individuals of financial assistance provided by the Federal 
        Government and by States and political subdivisions thereof for 
        the purpose of assisting such individuals with the payment of 
        employee contributions to group health plans, and
            ``(2) to promote and facilitate the establishment of 
        alternative group purchasing or pooling arrangements, such as 
        purchasing cooperatives for small businesses, reinsurance 
        pools, or high risk pools.
    ``(b) Intergovernmental Consultation.--Under such program, the 
Secretary shall--
            ``(1) provide for such ongoing consultation with agencies 
        and instrumentalities of the Federal Government and of the 
        States and political subdivisions thereof as is necessary and 
        appropriate to further the purposes such program, and
            ``(2) submit to each House of the Congress such 
        recommendations for such legislative changes as the Secretary 
        may, from time to time, consider to be appropriate to further 
        the purposes of such program.
    ``(c) Safeguards to Ensure Maintenance of Current Levels of 
Governmental Support for Health Care.--The Secretary shall ensure that 
participation in the program by any State or political subdivision 
thereof with respect to financial assistance described in subsection 
(a)(1) may not occur unless the Secretary finds that any reallocation 
of funds by such State or political subdivision in connection with 
participation in the program does not result in a decrease in the 
number of individuals in the applicable jurisdiction who have 
substantial coverage for health benefits under either public or private 
programs.''.
    (b) Deadline for Establishing Program.--The Secretary of Labor 
shall issue initial final regulations necessary to carry out the 
program established under section 518 of the Employee Retirement Income 
Security Act of 1974 (added by section 2) not later than December 31, 
2004.
    (c) Clerical Amendments.--The table of contents in section 1 of 
such Act is amended by inserting after the item relating to section 517 
the following new items:

``Sec. 518. Authority to postpone certain deadlines by reason of 
                            Presidentially declared disaster or 
                            terroristic or military actions.
``Sec. 519. Promotion and facilitation of coverage under group health 
                            plans.''.

SEC. 3. NOTIFICATION TO PARTICIPANTS IN EMPLOYEE BENEFIT PLANS OF 
              AVAILABILITY OF CHILD HEALTH ASSISTANCE UNDER SCHIP AND 
              CASH BENEFITS AVAILABLE UNDER SSI.

    (a) In General.--Section 104 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1024) is amended--
            (1) by redesignating subsection (d) as subsection (e); and
            (2) by inserting after subsection (c) the following new 
        subsection:
    ``(d)(1) The administrator of an employee benefit plan shall 
include in each summary plan description, updated summary plan 
description, and summary description of a modification or change to the 
plan which is furnished to participants, and shall provide separately 
to individuals claiming benefits under the plan, a summary description 
of--
            ``(A) the child health assistance available under State 
        child health plans under title XXI of the Social Security Act, 
        and
            ``(B) the cash benefits available to eligible elderly or 
        disabled individuals with limited income and resources under 
        the supplemental security income program under title XVI of the 
        Social Security Act.
    ``(2) The summary description required under paragraph (1) shall--
            ``(A) be in a form which shall be prescribed in regulations 
        of the Secretary, in consultation with the Secretary of Health 
        and Human Services,
            ``(B) be written in a manner calculated to be understood by 
        the average plan participant, and
            ``(C) include--
                    ``(i) the appropriate telephone number, Internet 
                website, and mailing address for the State program 
                providing the assistance described in paragraph (1)(A) 
                in the State in which the participant or beneficiary 
                resides, and
                    ``(ii) the appropriate telephone number, Internet 
                website, and mailing address for the supplemental 
                security income program described in paragraph (1)(B),
        together with the benefits information applicable to such 
        programs.''.
    (b) Enforcement.--Section 502(c)(1)(A) of such Act (29 U.S.C. 
1132(c)(1)) is amended by striking ``paragraph (1) or (4) of section 
606 or section 101(e)(1)'' and inserting ``section 101(e)(1), section 
104(d), or paragraph (1) or (4) of section 606''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to summary plan descriptions, updated summary plan 
descriptions, and summary descriptions of plan modifications or changes 
furnished to participants or beneficiaries, and in connection with 
benefit claims filed, after December 31, 2003.

SEC. 4. PROHIBITION OF LIFETIME LIMITS IN GROUP HEALTH PLANS.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 is amended by 
adding at the end the following new section:

``SEC. 714. PROHIBITION ON APPLICATION OF LIFETIME LIMITATIONS.

    ``(a) Requirement.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, may not impose any 
aggregate lifetime limit on benefits, including any category of 
benefits, under the plan or coverage.
    ``(b) Notice Under Group Health Plan.--The imposition of the 
requirement of this section shall be treated as a material modification 
in the terms of the plan described in section 102(a)(1), for purposes 
of assuring notice of such requirements under the plan; except that the 
summary description required to be provided under the last sentence of 
section 104(b)(1) with respect to such modification shall be provided 
by not later than 60 days after the first day of the first plan year in 
which such requirement apply.''.
    (b) Conforming Amendments.--
            (1) Section 731(c) of such Act (29 U.S.C. 1191(c)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 714''.
            (2) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is 
        amended by striking ``section 711'' and inserting ``sections 
        711 and 714''.
            (3) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 713 the 
        following new item:

``Sec. 714. Prohibition on application of lifetime limitations.''.
    (c) Effective Dates.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section apply with respect to group health plans 
        for plan years beginning on or after January 1, 2005.
            (2) Collective bargaining exception.--In the case of a 
        group health plan maintained pursuant to 1 or more collective 
        bargaining agreements between employee representatives and 1 or 
        more employers ratified before the date of enactment of this 
        Act, the amendments made by this section shall not apply to 
        plan years beginning before the later of--
                    (A) the date on which the last collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of enactment of this Act), or
                    (B) January 1, 2005.
        For purposes of subparagraph (A), any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by this section shall not be treated as a termination of 
        such collective bargaining agreement.

SEC. 5. PROHIBITION OF DISCRIMINATION BASED ON PRE-EXISTING CONDITIONS.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 (as amended by 
section 4) is amended further by adding at the end the following new 
section:

``SEC. 715. PROHIBITION ON DISCRIMINATION BASED ON PRE-EXISTING 
              CONDITIONS.

    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, may not impose any 
change in the premium rates charged for coverage of participants and 
beneficiaries under the plan so as to result in a premium charged to 
any such participant or beneficiary which is above that which is 
charged to otherwise similarly situated individuals solely on the basis 
of a pre-existing condition of such participant or beneficiary.
    ``(b) Notice Under Group Health Plan.--The imposition of the 
requirement of this section shall be treated as a material modification 
in the terms of the plan described in section 102(a)(1), for purposes 
of assuring notice of such requirements under the plan; except that the 
summary description required to be provided under the last sentence of 
section 104(b)(1) with respect to such modification shall be provided 
by not later than 60 days after the first day of the first plan year in 
which such requirement apply.
    ``(c) Pre-Existing Condition.--For purposes of this section, the 
term `pre-existing condition' means, in connection with any change in 
premium rates charged for coverage of a participant or beneficiary, a 
medical condition of the participant or beneficiary that was present 
before the effective date of the change in premium rates, whether or 
not any medical advice, diagnosis, care, or treatment was recommended 
or received before such date.''.
    (b) Conforming Amendments.--
            (1) Section 732(a) of such Act (as amended by section 4 of 
        this Act) is amended further by striking ``sections 711 and 
        714'' and inserting ``sections 711, 714, and 715''.
            (2) The table of contents in section 1 of such Act (as 
        amended by section 4 of this Act) is amended further by 
        inserting after the item relating to section 714 the following 
        new item:

``Sec. 715. Prohibition on discrimination based on pre-existing 
                            conditions.''.
    (c) Effective Dates.--
            (1) In general.--Subject to paragraph (2), the amendments 
        made by this section apply with respect to group health plans 
        for plan years beginning on or after January 1, 2005.
            (2) Collective bargaining exception.--In the case of a 
        group health plan maintained pursuant to 1 or more collective 
        bargaining agreements between employee representatives and 1 or 
        more employers ratified before the date of enactment of this 
        Act, the amendments made by this section shall not apply to 
        plan years beginning before the later of--
                    (A) the date on which the last collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of enactment of this Act), or
                    (B) January 1, 2005.
        For purposes of subparagraph (A), any plan amendment made 
        pursuant to a collective bargaining agreement relating to the 
        plan which amends the plan solely to conform to any requirement 
        added by this section shall not be treated as a termination of 
        such collective bargaining agreement.

SEC. 6. PAYMENTS BY PENSION AND ANNUITY PLANS FOR COBRA BENEFITS.

    (a) In General.--Section 401 of the Internal Revenue Code of 1986 
is amended by redesignating subsection (o) as subsection (p) and by 
inserting after subsection (n) the following new subsection:
    ``(o) Payments by Plans for Continuation Coverage Premiums.--Under 
regulations prescribed by the Secretary, a pension or annuity plan 
shall not be considered as not satisfying the requirements of 
subsection (a) merely because the plan makes payments for premiums for 
continuation coverage under a group health plan on behalf of a 
qualified beneficiary which meet the requirements of section 4980B(f), 
but such a plan making such payments shall be considered as not 
satisfying such requirements unless such benefits are subordinate to 
the retirement benefits provided by the plan and to the qualified 
current retiree health liabilities (as defined in section 420) of a 
health benefits account which is part of such plan.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to taxable years beginning after the date of the enactment of 
this Act.

SEC. 7. NOTICE TO PARTICIPANTS AND BENEFICIARIES CLAIMING GROUP HEALTH 
              PLAN BENEFITS OF AVAILABILITY OF SSI BENEFITS.

    (a) In General.--Section 609 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1169) is amended--
            (1) by redesignating subsection (e) as subsection (f); and
            (2) by inserting after subsection (d) the following new 
        subsection:
    ``(e) Notice to Claimant of Available SSI Benefits.--Upon receipt 
of a claim for benefits under a group health plan, the administrator of 
such plan shall, not later than 30 days after receipt of the claim, 
provide to the claimant written notice of the availability to eligible 
elderly or disabled individuals with limited income and resources to 
cash benefits under the supplemental security income program under 
title XVI of the Social Security Act. Such notice shall be in a form 
which shall be prescribed by the Secretary of Health and Human 
Services.''.
    (b) Enforcement.--Section 502(c)(1)(A) of such Act (as amended by 
section 3(b)) is amended further by striking ``or paragraph (1) or (4) 
of section 606'' and inserting ``paragraph (1) or (4) of section 606, 
or section 609(e)''.
    (c) Effective Date.--The amendments made by this section shall 
apply in connection with claims for benefits filed during plan years 
beginning on or after January 1, 2005.

SEC. 8. REQUIREMENT FOR QUALIFIED INDIVIDUALS WHO OBTAIN EMERGENCY ROOM 
              SERVICES TO MAINTAIN SUBSTANTIAL HEALTH INSURANCE 
              COVERAGE FOR 2 YEARS.

    (a) Alienation of Pension Benefits to Enforce Court Order to 
Maintain Coverage.--Section 206 of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1056) is amended by adding at the end 
the following new subsection:
    ``(g) Alienation of Pension Benefits to Enforce Certain Court 
Orders to Maintain Substantial Health Insurance Coverage.--
            ``(1) Alienation of pension benefits.--Subsection (d)(1) 
        shall not apply in connection with any pension plan with 
        respect to amounts payable, by an individual who is a 
        participant or beneficiary under such plan and fails to meet 
        the requirements of paragraph (2), for the purpose of acquiring 
        and maintaining health insurance coverage pursuant to an order 
        of a court of competent jurisdiction under section 502(c)(7).
            ``(2) Requirement of coverage upon obtaining emergency room 
        services.--In any case in which emergency room services are 
        obtained for a qualified individual or for such individual's 
        spouse or dependent, such individual shall be treated as 
        failing to meet the requirements of this paragraph with respect 
        to the patient if, at the time that such services are obtained, 
        such patient is not covered under substantial health insurance 
        coverage.
            ``(3) Definitions.--For purposes of this subsection--
                    ``(A) Qualified individual.--The term `qualified 
                individual' means an individual whose adjusted gross 
                income for the taxable year preceding the time 
                emergency room services described in paragraph (2) are 
                obtained is greater than or equal to 500 percent of the 
                poverty line (as defined by the Office of Management 
                and Budget).
                    ``(B) Emergency room services.--The term `emergency 
                room services' means medical care at a hospital 
                emergency department (as defined for purposes of 
                section 1867 of the Social Security Act (42 U.S.C. 
                1395dd)).''.
                    ``(C) Substantial health insurance coverage.--
                            ``(i) In general.--The term `substantial 
                        health insurance coverage' means health 
                        insurance coverage (within the meaning of 
                        section 733(b)(1)) which is determined by the 
                        Secretary (in consultation with the Secretary 
                        of Health and Human Services) to meet the 
                        following requirements:
                                    ``(I) Aggregate actuarial value 
                                equivalent to benchmark package.--The 
                                coverage has an aggregate actuarial 
                                value that is at least actuarially 
                                equivalent to one of the benchmark 
                                benefit packages.
                                    ``(II) Inclusion of basic 
                                services.--The coverage includes 
                                benefits for items and services within 
                                each of the categories of basic 
                                services described in clause (iii).
                                    ``(III) Substantial actuarial value 
                                for additional services included in 
                                benchmark package.--With respect to 
                                each of the categories of additional 
                                services described in clause (iv) for 
                                which coverage is provided under the 
                                benchmark benefit package used under 
                                subclause (I), the coverage has an 
                                actuarial value that is equal to at 
                                least 75 percent of the actuarial value 
                                of the coverage of that category of 
                                services in such package.
                            ``(ii) Benchmark benefit packages.--The 
                        benchmark benefit packages are as follows:
                                    ``(I) Fehbp-equivalent health 
                                insurance coverage.--The standard Blue 
                                Cross/Blue Shield preferred provider 
                                option service benefit plan, described 
                                in and offered under section 8903(1) of 
                                title 5, United States Code.
                                    ``(II) State employee coverage.--A 
                                health benefits coverage plan that is 
                                offered and generally available to 
                                State employees in the State involved.
                                    ``(III) Coverage offered through 
                                hmo.--The health insurance coverage 
                                plan that is offered by a health 
                                maintenance organization (as defined in 
                                section 2791(b)(3) of the Public Health 
                                Service Act), and has the largest 
                                insured commercial, non-medicaid 
                                enrollment of covered lives of such 
                                coverage plans offered by such a health 
                                maintenance organization in the State 
                                involved.
                            ``(iii) Categories of basic services.--For 
                        purposes of this subparagraph, the categories 
                        of basic services described in this clause are 
                        as follows:
                                    ``(I) Inpatient and outpatient 
                                hospital services.
                                    ``(II) Physicians' surgical and 
                                medical services.
                                    ``(III) Laboratory and x-ray 
                                services.
                                    ``(IV) Well-baby and well-child 
                                care, including age-appropriate 
                                immunizations.
                            ``(iv) Categories of additional services.--
                        For purposes of this subparagraph, the 
                        categories of additional services described in 
                        this clause are as follows:
                                    ``(I) Coverage of prescription 
                                drugs.
                                    ``(II) Mental health services.
                                    ``(III) Vision services.
                                    ``(IV) Hearing services.
                            ``(v) Treatment of other categories.--
                        Nothing in this subparagraph shall be construed 
                        as preventing substantial health insurance 
                        coverage from including coverage of benefits 
                        that are not within a category of services 
                        described in clause (iii) or (iv).
                            ``(vi) Determination of actuarial value.--
                        The actuarial value of coverage of benchmark 
                        benefit packages and coverage of any categories 
                        of additional services under benchmark benefit 
                        packages and under coverage offered by such a 
                        plan shall be set forth in an actuarial opinion 
                        in an actuarial report that has been prepared--
                                    ``(I) by an individual who is a 
                                member of the American Academy of 
                                Actuaries;
                                    ``(II) using generally accepted 
                                actuarial principles and methodologies;
                                    ``(III) using a standardized set of 
                                utilization and price factors;
                                    ``(IV) using a standardized 
                                population that is representative of 
                                privately insured individuals similarly 
                                situated when compared to individuals 
                                expected to be covered under the 
                                substantial health insurance coverage;
                                    ``(V) applying the same principles 
                                and factors in comparing the value of 
                                different coverage (or categories of 
                                services); and
                                    ``(VI) without taking into account 
                                any differences in coverage based on 
                                the method of delivery or means of cost 
                                control or utilization used.
                        The actuary preparing the opinion shall select 
                        and specify in the memorandum the standardized 
                        set and population to be used under subclauses 
                        (III) and (IV).''.
    (b) Remedy Against Qualified Individuals for not Maintaining 
Substantial Health Insurance Coverage While Obtaining Emergency Room 
Services.--
            (1) In general.--Section 502 of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1102) is amended--
                    (A) in subsection (a)(8), by striking ``or'' at the 
                end;
                    (B) in subsection (a)(9), by striking the period 
                and inserting ``; or'';
                    (C) by adding at the end of subsection (a) the 
                following new paragraph:
            ``(10) by the Secretary or a State, in accordance with 
        subsection (c)(7), to provide appropriate equitable remedies 
        for failures to meet the requirements of section 206(g)(2).'';
                    (D) by redesignating subsection (c)(8) as 
                subsection (c)(9); and
                    (E) by inserting after subsection (c)(7) the 
                following new paragraph:
    ``(8) In any action under subsection (a)(10), the court may provide 
appropriate equitable relief in connection with failures to meet the 
requirements of section 206(g)(2). Such relief may include an order 
that the defendant maintain, for at least the 2-year period commencing 
with the date of the failure described in section 206(g)(2), 
substantial health insurance coverage (as defined in section 
206(g)(3)(B)) covering the patient involved.''.
            (2) Concurrent jurisdiction.--Section 502(e)(1) of such Act 
        (29 U.S.C. 1132(e)(1)) is amended--
                    (A) in the first sentence, by striking ``subsection 
                (a)(1)(B)'' and inserting ``paragraph (1)(B), (7), or 
                (10) of subsection (a) of this section''; and
                    (B) in the last sentence, by striking ``paragraphs 
                (1)(B) and (7)'' and inserting ``paragraphs (1)(B), 
                (7), and (10)''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to failures (to meet the requirements of section 
206(g)(2) of the Employee Retirement Income Security Act of 1974) 
occurring on or after the date of the enactment of this Act.
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