[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1085 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1085

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 13, 2009

Ms. Eshoo (for herself, Mr. Altmire, Mr. Langevin, Ms. Sutton, and Mr. 
   Kildee) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, 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 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 ``Health Insurance Coverage Protection 
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 (29 U.S.C. 1185 et 
seq.) is amended by adding at the end the following:

``SEC. 715. 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 2 plan years after the 
        effective date of this section, $5,000,000;
            ``(2) with respect to the third and fourth plan years after 
        such date, $10,000,000; and
            ``(3) with respect to each subsequent year, the amount for 
        the previous year adjusted by the percentage increase in the 
        consumer price index (for all urban consumers) for such year;
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, except that upon 
        the request of such a small employer, the plan involved shall 
        provide for the application of an aggregate dollar lifetime 
        limit that is consistent with the limit required under such 
        subsection.
            ``(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, is amended by inserting after the item relating to section 714 the 
following new item:

``Sec. 715. 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 
1 year after the date of enactment of this Act.

SEC. 3. AMENDMENT 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 (42 U.S.C. 300gg-4 et seq.) is amended by adding at 
the end the following:

``SEC. 2708. 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 2 plan years after the 
        effective date of this section, $5,000,000;
            ``(2) with respect to the third and fourth plan years after 
        such date, $10,000,000; and
            ``(3) with respect to each subsequent year, the amount for 
        the previous year adjusted by the percentage increase in the 
        consumer price index (for all urban consumers) for such year;
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, except that upon 
        the request of such a small employer, the plan involved shall 
        provide for the application of an aggregate dollar lifetime 
        limit that is consistent with the limit required under such 
        subsection.
            ``(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 1 
year after the date of enactment of this Act.

SEC. 4. STUDY BY THE INSTITUTE OF MEDICINE.

    The Secretary of Health and Human Services shall enter into a 
contract with the Institute of Medicine for the conduct of a study to 
determine the number of individuals who have reached the lifetime 
limitations set forth in the amendments made by this Act beginning in 
the third plan year for which such amendments apply. Not later than 1 
year after the date on which the study is conducted under the previous 
sentence, the Institute of Medicine shall submit to the Secretary and 
the appropriate committees of Congress a report concerning the results 
of the study.
                                 <all>