[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5449 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 5449

 To amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to prohibit 
discrimination in group health coverage and individual health insurance 
                               coverage.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 14, 2008

Mr. Kagen (for himself, Mr. Braley of Iowa, Mr. Perlmutter, Mr. Cohen, 
    Mr. McNerney, Ms. Castor, Mr. Walz of Minnesota, Mr. Johnson of 
  Georgia, Mr. Grijalva, Ms. Hirono, Mrs. Napolitano, Ms. Sutton, Ms. 
 Clarke, Mr. Conyers, and Mr. Ellison) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
 addition to the Committees on Education and Labor and 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 amend the Employee Retirement Income Security Act of 1974, Public 
 Health Service Act, and the Internal Revenue Code of 1986 to prohibit 
discrimination in group health coverage and individual health 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; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``No Discrimination 
in Health Insurance Act of 2008''.
    (b) Purpose.--It is the purpose of this Act to--
            (1) eliminate the application of pre-existing condition 
        exclusions in all group health coverage policies and all 
        individual health insurance policies; and
            (2) provide that all health insurance issuers determine and 
        openly disclose the premium price for each and every group 
        health insurance policy and each and every individual health 
        insurance policy, such that within a specific metropolitan 
        statistical area, or other geographic area, all such premiums 
        and prices established by a given issuer shall be uniform.

SEC. 2. NONDISCRIMINATION IN GROUP HEALTH COVERAGE.

    (a) Application Under the Employee Retirement Income Security Act 
of 1974.--
            (1) Elimination of preexisting condition exclusions.--
        Section 701 of the Employee Retirement Income Security Act of 
        1974 (29 U.S.C. 1181) is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of preexisting condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, with respect to a 
participant or beneficiary--
            ``(1) may not impose any pre-existing condition exclusion; 
        and
            ``(2) in the case of a group health plan that offers 
        medical care through health insurance coverage offered by a 
        health maintenance organization, may not provide for an 
        affiliation period with respect to coverage through the 
        organization.'';
                    (C) in subsection (b), by striking paragraph (3) 
                and inserting the following:
            ``(3) Affiliation period.--The term `affiliation period' 
        means a period which, under the terms of the health insurance 
        coverage offered by the health maintenance organization, must 
        expire before the health insurance coverage becomes 
        effective.'';
                    (D) by striking subsections (c), (d), (e), and (g); 
                and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Clerical amendment.--The item in the table of contents 
        of such Act relating to section 701 is amended to read as 
        follows:

``Sec. 701. Elimination of pre-existing condition exclusions.''.
    (b) Application Under the Internal Revenue Code of 1986.--
            (1) Elimination of preexisting condition exclusions.--
        Section 9801 of the Internal Revenue Code of 1986 is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of preexisting condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan with respect to a 
participant or beneficiary may not impose any pre-existing condition 
exclusion.'';
                    (C) by striking paragraph (3) of subsection (b);
                    (D) by striking subsections (c), (d), and (e); and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Clerical amendment.--The item in the table of sections 
        of chapter 100 of such Code relating to section 9801 is amended 
        to read as follows:

``Sec. 9801. Elimination of preexisting condition exclusions.''.
    (c) Application Under Public Health Service Act.--
            (1) Elimination of preexisting condition exclusions.--
        Section 2701 of the Public Health Service Act (42 U.S.C. 300gg) 
        is amended--
                    (A) by amending the heading to read as follows: 
                ``elimination of preexisting condition exclusions'';
                    (B) by amending subsection (a) to read as follows:
    ``(a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, with respect to a 
participant or beneficiary--
            ``(1) may not impose any pre-existing condition exclusion; 
        and
            ``(2) in the case of a group health plan that offers 
        medical care through health insurance coverage offered by a 
        health maintenance organization, may not provide for an 
        affiliation period with respect to coverage through the 
        organization.'';
                    (C) in subsection (b), by striking paragraph (3) 
                and inserting the following:
            ``(3) Affiliation period.--The term `affiliation period' 
        means a period which, under the terms of the health insurance 
        coverage offered by the health maintenance organization, must 
        expire before the health insurance coverage becomes 
        effective.'';
                    (D) by striking subsections (c), (d), (e), and (g); 
                and
                    (E) by redesignating subsection (f) (relating to 
                special enrollment periods) as subsection (c).
            (2) Guaranteed availability of group health insurance 
        coverage to employers of all sizes in the group market.--
        Section 2711 of such Act (42 U.S.C. 300gg-11) is amended--
                    (A) in subsection (a)--
                            (i) in the heading, by striking ``Small'';
                            (ii) in paragraph (1), by striking ``(c) 
                        through (f)'' and inserting ``(b) through 
                        (d)'';
                            (iii) in paragraph (1), in the matter 
                        before subparagraph (A), by striking ``small'';
                            (iv) in paragraph (1)(A), by striking 
                        ``small employer (as defined in section 
                        2791(e)(4))'' and inserting ``employer'';
                            (v) in paragraph (2), by striking ``small'' 
                        each place it appears; and
                            (vi) in paragraph (2), by striking 
                        ``coverage to a'' and inserting ``coverage to 
                        an'';
                    (B) by striking subsection (b);
                    (C) in subsections (c), (d), and (e), by striking 
                ``small'' each place it appears; and
                    (D) by striking subsection (f).
            (3) Application of uniform premiums.--Section 2711 of such 
        Act, as so amended, is amended by inserting after subsection 
        (a) the following new subsection:
    ``(b) Application of Uniform Premium.--
            ``(1) In general.--Each and every health insurance issuer 
        that offers health insurance coverage in the group market in a 
        State shall--
                    ``(A) shall charge the same premium price for the 
                same coverage; and
                    ``(B) shall openly disclose, in a manner specified 
                by the Secretary and including disclosure through the 
                Internet, the amount of the premium price that is being 
                charged for the coverage involved.
            ``(2) Uniform application to family coverage and to 
        different geographic areas.--Paragraph (1) shall be applied 
        uniformly--
                    ``(A) for coverage on the basis of such different 
                family categories as the Secretary approves; and
                    ``(B) for coverage within each metropolitan 
                statistical area and for coverage within the portions 
                of a State that are not within a metropolitan 
                statistical area.
            ``(3) Application.--Paragraph (1) shall not be construed as 
        preventing variations in premiums that result from the 
        application of a uniform monthly premium over different policy 
        years.''.
            (4) Application of nondiscrimination rules to nonfederal 
        governmental plans.--Section 2721(b)(2)(A) of such Act (42 
        U.S.C. 300gg-21(b)(2)(A)) is amended by striking ``subparts 1 
        through 3'' and ``such subparts'' and inserting ``subpart 2'' 
        and ``such subpart'', respectively.
    (d) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply to plan years beginning on or after January 1, 2009, 
        regardless of whether an individual is provided coverage under 
        a group health plan before such date.
            (2) Special rule for collective bargaining agreements.--In 
        the case of a group health plan maintained pursuant to one or 
        more collective bargaining agreements between employee 
        representatives and one or more employers ratified before the 
        date of the 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 of the collective 
                bargaining agreements relating to the plan terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of the enactment of this Act), 
                or
                    (B) January 1, 2010.
        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 
        under the amendments made by this section shall not be treated 
        as a termination of such collective bargaining agreement.

SEC. 3. NONDISCRIMINATION IN INDIVIDUAL HEALTH INSURANCE.

    (a) In General.--Section 2741 of the Public Health Service Act (42 
U.S.C. 300gg-41) is amended--
            (1) by amending the heading to read as follows: 
        ``guaranteed issue of individual health insurance coverage; 
        uniform premiums'';
            (2) by amending subsections (a) and (b) to read as follows:
    ``(a) In General.--
            ``(1) Guaranteed issue.--Subject to the succeeding 
        subsections of this section, each and every health insurance 
        issuer that offers health insurance coverage (as defined in 
        section 2791(b)(1)) in the individual market to individuals 
        residing in an area may not, with respect to an eligible 
        individual (as defined in subsection (b)) residing in the area 
        who desires to enroll in individual health insurance coverage--
                    ``(A) decline to offer such coverage to, or deny 
                enrollment of, such individual; or
                    ``(B) impose any preexisting condition exclusion 
                (as defined in section 2701(b)(1)(A)) with respect to 
                such coverage.
            ``(2) Application of uniform premium.--
                    ``(A) In general.--Each and every health insurance 
                issuer that offers health insurance coverage in the 
                individual market in a State--
                            ``(i) shall charge the same premium price 
                        for the same coverage;
                            ``(ii) if the issuer offers such coverage 
                        in the group market in the State, shall charge 
                        the same premium for the same coverage offered 
                        in the group market; and
                            ``(iii) shall openly disclose, in a manner 
                        specified by the Secretary and including 
                        disclosure through the Internet, the amount of 
                        the premium price that is being charged for the 
                        coverage involved.
                    ``(B) Uniform application to family coverage and to 
                different geographic areas.--Subparagraph (A) shall be 
                applied uniformly--
                            ``(i) for coverage on the basis of such 
                        different family categories as the Secretary 
                        approves; and
                            ``(ii) for coverage within each 
                        metropolitan statistical area and for coverage 
                        within the portions of a State that are not 
                        within a metropolitan statistical area.
                    ``(C) Application.--Subparagraph (A) shall not be 
                construed as preventing variations in premiums that 
                result from the application of a uniform monthly 
                premium over different policy years.
    ``(b) Eligible Individual Defined.--In this part, the term 
`eligible individual' means, with respect to an area, an individual who 
resides in such area, without regard to the period of such residency, 
and who is--
            ``(1) a citizen or national of the United States;
            ``(2) an alien lawfully admitted to the United States for 
        permanent residence; or
            ``(3) an alien who is otherwise lawfully residing in the 
        United States.'';
            (3) by striking subsection (c);
            (4) by redesignating subsection (d) and the first 
        subsection (e) (relating to application of financial capacity 
        limits) as subsections (c) and (d), respectively;
            (5) in paragraph (1) of the subsection (e) relating to 
        market requirements, by striking ``or through one or more bona 
        fide associations, or both''; and
            (6) by striking subsection (f) and inserting the following:
    ``(f) Uniform Rules To Respond to Adverse Selection.--
            ``(1) In general.--The Secretary may establish rules for 
        uniform application that are designed to deter individuals--
                    ``(A) from enrolling in individual health insurance 
                coverage only after they develop an illness or injury 
                for which such coverage applies; and
                    ``(B) from disenrolling from health insurance 
                coverage for periods in which they are unlikely (or 
                less likely) to require such coverage.
            ``(2) Considerations.--Such rules may take into account the 
        financial and other circumstances of individuals for not being 
        so enrolled or for so disenrolling.''.
    (b) Conforming Amendment.--Section 2742(b) of such Act (42 U.S.C. 
300gg-42(b)) is amended by striking paragraph (5).
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to health insurance coverage offered, sold, issued, 
renewed, in effect, or operated in the individual market after December 
31, 2008.
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