[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 437 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 437

  To amend the Internal Revenue Code of 1986 to require group health 
    plans to provide coverage for reconstructive surgery following 
mastectomy, consistent with the Women's Health and Cancer Rights Act of 
                                 1998.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 1, 2005

  Mrs. Kelly introduced the following bill; which was referred to the 
                      Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
  To amend the Internal Revenue Code of 1986 to require group health 
    plans to provide coverage for reconstructive surgery following 
mastectomy, consistent with the Women's Health and Cancer Rights Act of 
                                 1998.

    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 ``Women's Health and Cancer Rights 
Conforming Amendments of 2005''.

SEC. 2. CONFORMING THE INTERNAL REVENUE CODE OF 1986 TO REQUIREMENTS 
              IMPOSED BY THE WOMEN'S HEALTH AND CANCER RIGHTS ACT OF 
              1998.

    (a) In General.--Subchapter B of chapter 100 of the Internal 
Revenue Code of 1986 (relating to other requirements) is amended by 
inserting after section 9812 the following new section:

``SEC. 9813. REQUIRED COVERAGE FOR RECONSTRUCTIVE SURGERY FOLLOWING 
              MASTECTOMIES.

    ``(a) In General.--A group health plan that provides medical and 
surgical benefits with respect to a mastectomy shall provide, in a case 
of a participant or beneficiary who is receiving benefits in connection 
with a mastectomy and who elects breast reconstruction in connection 
with such mastectomy, coverage for--
            ``(1) all stages of reconstruction of the breast on which 
        the mastectomy has been performed,
            ``(2) surgery and reconstruction of the other breast to 
        produce a symmetrical appearance, and
            ``(3) prostheses and physical complications of mastectomy, 
        including lymphedemas,
in a manner determined in consultation with the attending physician and 
the patient. Such coverage may be subject to annual deductibles and 
coinsurance provisions as may be deemed appropriate and as are 
consistent with those established for other benefits under the plan. 
Written notice of the availability of such coverage shall be delivered 
to the participant upon enrollment and annually thereafter.
    ``(b) Prohibitions.--A group health plan may not--
            ``(1) deny to a patient eligibility, or continued 
        eligibility, to enroll or to renew coverage under the terms of 
        the plan, solely for the purpose of avoiding the requirements 
        of this section, and
            ``(2) penalize or otherwise reduce or limit the 
        reimbursement of an attending provider, or provide incentives 
        (monetary or otherwise) to an attending provider, to induce 
        such provider to provide care to an individual participant or 
        beneficiary in a manner inconsistent with this section.
    ``(c) Rule of Construction.--Nothing in this section shall be 
construed to prevent a group health plan from negotiating the level and 
type of reimbursement with a provider for care provided in accordance 
with this section.''
    (b) Clerical Amendment.--The table of sections for chapter 100 of 
such Code is amended inserting after the item relating to section 9812 
the following new item:

``Sec. 9813. Required coverage for reconstructive surgery following 
                            mastectomies.''
    (c) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply with respect to plan years beginning on or after the date 
        of enactment of this Act.
            (2) Special rule for collective bargaining agreements.--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, 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.
                                 <all>