[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 623 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 623
To amend title I of the Employee Retirement Income Security Act of
1974, title XXVII of the Public Health Service Act, and the Internal
Revenue Code of 1986 to prohibit pre-existing condition exclusions in
group health plans and in health insurance coverage in the group and
individual markets.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 17, 2009
Mr. Rockefeller (for himself, Mr. Lautenberg, and Mr. Brown) introduced
the following bill; which was read twice and referred to the Committee
on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend title I of the Employee Retirement Income Security Act of
1974, title XXVII of the Public Health Service Act, and the Internal
Revenue Code of 1986 to prohibit pre-existing condition exclusions in
group health plans and in health insurance coverage in the group and
individual markets.
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 ``Pre-existing Condition Patient
Protection Act of 2009''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) According to the United States Census Bureau,
45,700,000 individuals were uninsured in 2007.
(2) According to a recent study by the Commonwealth Fund,
the number of underinsured adults ages 19 to 64 has jumped 60
percent over the last 4 years, from 16,000,000 in 2003 to
25,000,000 in 2007.
(3) According to the Center for Disease Control and
Prevention, approximately 45 percent of Americans have at least
1 chronic condition.
(4) Forty-four States currently allow insurance companies
to deny coverage for, limit coverage for, or charge increased
premiums for a pre-existing condition.
(5) Over 26,000,000 individuals were enrolled in private
individual market health plans in 2007. Under the amendments
made by the Health Insurance Portability and Accountability Act
of 1996, these individuals have no protections against pre-
existing condition exclusions or waiting periods.
(6) When an individual has a 63-day gap in health insurance
coverage, pre-existing condition exclusions, such as limiting
coverage, can be placed on them when they become insured under
a new health insurance policy.
(7) Eliminating pre-existing condition exclusions for all
individuals is a vital safeguard to ensuring all Americans have
access to health care when in need.
(8) According to a Kaiser Family Foundation/Harvard School
of Public Health public opinion poll, 58 percent of Americans
strongly favor the Federal Government requiring health
insurance companies to cover anyone who applies for health
coverage, even if they have a prior illness.
SEC. 3. ELIMINATION OF PRE-EXISTING CONDITION EXCLUSIONS UNDER GROUP
HEALTH PLANS.
(a) Application Under the Employee Retirement Income Security Act
of 1974.--
(1) Elimination of pre-existing 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 pre-existing 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 Public Health Service Act.--
(1) Elimination of pre-existing 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 pre-existing 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) Technical amendments relating to employer size.--
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)--
(I) by striking ``(c) through (f)''
and inserting ``(b) through (d)'';
(II) in the matter before
subparagraph (A), by striking
``small''; and
(III) in subparagraph (A), by
striking ``small employer (as defined
in section 2791(e)(4))'' and inserting
``employer''; and
(iii) in paragraph (2)--
(I) by striking ``small'' each
place it appears; and
(II) 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).
(c) Application Under the Internal Revenue Code of 1986.--
(1) Elimination of pre-existing condition exclusions.--
Section 9801 of the Internal Revenue Code of 1986 is amended--
(A) by amending the heading to read as follows:
``Elimination of pre-existing 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 pre-existing condition exclusions.''.
(d) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply with respect to
group health plans for plan years beginning after the end of
the 12th calendar month following the date of the enactment of
this Act.
(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) the date that is after the end of the 12th
calendar month following the date of enactment of this
Act.
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 the amendments made by this section shall not be
treated as a termination of such collective bargaining
agreement.
SEC. 4. NONDISCRIMINATION IN INDIVIDUAL HEALTH INSURANCE.
(a) In General.--Section 2741 of the Public Health Service Act (42
U.S.C. 300gg-41) is amended by striking subsection (a) and inserting
the following:
``(a) In General.--
``(1) Guaranteed issue.--Subject to the succeeding
subsections of this section, each 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 pre-existing condition exclusion
(as defined in section 2701(b)(1)(A)) with respect to
such coverage.''.
(b) 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 the end
of the 12th calendar month following the date of the enactment of this
Act.
SEC. 5. TRANSPARENCY IN CLAIMS DATA.
(a) Report on Adverse Selection.--Not later than 2 years after the
date of enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report concerning the occurrence of
adverse selection as a result of the enactment of this Act. Such report
shall be based on the data reported under subsection (b).
(b) Mandatory Reporting.--A health insurance issuer to which this
Act applies, shall upon the request of the Secretary, submit to the
Secretary of Health and Human Services, data concerning--
(1) the number of new enrollees in health plans offered by
the issuer during the year involved;
(2) the number of enrollees who re-enrolled in health plans
offered by the issuer during the year involved;
(3) the demographic characteristics of enrollees;
(4) the number, nature, and dollar amount of claims made by
enrollees during the year involved;
(5) the number of enrollees who disenrolled or declined to
be re-enrolled during the year involved; and
(6) any other information determined appropriate by such
Secretary.
(c) Enforcement.--Part C of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-91 et seq.) is amended by adding at the
end the following:
``SEC. 2793. PROVISION OF INFORMATION.
``(a) In General.--The Secretary shall require that group health
plans and health insurance issuers to which this Act applies provide
data to the Secretary, at such times and in such manner as the
Secretary may require, in order to permit the Secretary to monitor
compliance with the requirements of this Act (including requirements
imposed under the Pre-existing Condition Patient Protection Act of 2009
(and the amendment made by that Act)).
``(b) Civil Penalties.--
``(1) In general.--A group health plan or health insurance
issuer that fails to provide information as required under
subsection (a) shall be subject to a civil money penalty under
this section.
``(2) Amount of penalty.--
``(A) In general.--The maximum amount of penalty
imposed under this paragraph is $100 per covered life
for each day that the plan or issuer fails to comply
with this section.
``(B) Consideration in imposition.--In determining
the amount of any penalty to be assessed under this
paragraph, the Secretary shall take into account the
previous record of compliance of the entity being
assessed with this section and the gravity of the
violation.''.
SEC. 6. REPORT ON AFFORDABLE HEALTH INSURANCE COVERAGE.
Not later than 12 months after the date of enactment of this Act,
the Government Accountability Office shall submit to the Secretary of
Health and Human Services a report concerning the impact of this Act
and other Federal laws relating to the regulation of health insurance
and its effect on the affordability of health insurance coverage for
individuals in all insurance markets and a description of the effect of
this Act on the expansion of coverage and reductions in the number of
uninsured and underinsured.
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