[Congressional Record Volume 154, Number 151 (Tuesday, September 23, 2008)]
[House]
[Pages H8666-H8668]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




HEALTH INSURANCE RESTRICTIONS AND LIMITATIONS CLARIFICATION ACT OF 2008

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 6908) to require that limitations and restrictions on 
coverage under group health plans be timely disclosed to group health 
plan sponsors and timely communicated to participants and beneficiaries 
under such plans in a form that is easily understandable, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 6908

       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 
     Restrictions and Limitations Clarification Act of 2008''.

     SEC. 2. DISCLOSURE REQUIREMENTS.

       (a) ERISA.--Section 702(a)(2)(B) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1182(a)(2)(B)) is 
     amended by inserting before the period at the end the 
     following: ``so long as--
       ``(i) such limitations and restrictions are explicit and 
     clear;
       ``(ii) in the case of such limitations and restrictions in 
     health insurance coverage offered in connection with the 
     group health plan, such limitations and restrictions have 
     been disclosed in writing to the plan sponsor in advance of 
     the point of sale to the plan;
       ``(iii) the plan sponsor of the health insurance coverage 
     provide, to participants and beneficiaries in the plan in 
     advance of the point of their enrollment under the plan, a 
     description of such limitations and restrictions in a form 
     that is easily understandable by such participants and 
     beneficiaries; and
       ``(iv) the plan sponsor and the issuer of the coverage 
     provide such description to participants and beneficiaries 
     upon their enrollment under the plan at the earliest 
     opportunity that other materials are provided''.
       (b) PHSA.--Section 2702(a)(2)(B) of the Public Health 
     Service Act (42 U.S.C. 300gg-1(a)(2)(B)) is amended by 
     inserting before the period at the end the following: ``so 
     long as--
       ``(i) such limitations and restrictions are explicit and 
     clear;
       ``(ii) in the case of such limitations and restrictions in 
     health insurance coverage offered in connection with the 
     group health plan, such limitations and restrictions have 
     been disclosed in writing to the plan sponsor in advance of 
     the point of sale to the plan;
       ``(iii) the plan sponsor and the issuer of the group health 
     insurance coverage make available, to participants and 
     beneficiaries in the

[[Page H8667]]

     plan in advance of the point of their enrollment under the 
     plan, a description of such limitations and restrictions in a 
     form that is easily understandable by such participants and 
     beneficiaries; and
       ``(iv) the plan sponsor and the issuer of the coverage 
     provides such description to participants and beneficiaries 
     upon their enrollment under the plan at the earliest 
     opportunity that other materials are provided''.
       (c) Internal Revenue Code.--Section 9802(a)(2)(B) of the 
     Internal Revenue Code of 1986 is amended by inserting before 
     the period at the end the following: ``so long as--
       ``(i) such limitations and restrictions are explicit and 
     clear;
       ``(ii) the group health plan makes available, to 
     participants and beneficiaries in the plan in advance of the 
     point of their enrollment under the plan, a description of 
     such limitations and restrictions in a form that is easily 
     understandable by such participants and beneficiaries; and
       ``(iii) the plan provides such description to participants 
     and beneficiaries upon their enrollment under the plan at the 
     earliest opportunity that other materials are provided''.
       (d) Effective Date.--The amendments made by this Act shall 
     apply with respect to plan years beginning after 1 year after 
     the date of the enactment of this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of H.R. 6908, the Health 
Insurance Source of Injury Clarification Act of 2008. This bill would 
prohibit health insurers from restricting or denying benefits to plan 
participants if they are injured while engaging in legal recreational 
activities like riding a motorcycle, skiing, snowmobiling or horseback 
riding unless such restrictions were made explicitly clear by the plan 
to the person before he or she enrolled.
  Mr. Speaker, this change is necessary because of a 2001 rule that was 
issued in accordance with the Health Insurance Portability and 
Accountability Act of 1996.

                              {time}  1945

  While that 1996 rule prohibits employer health plans and insurers 
from denying coverage to individuals who engage in legal recreational 
activities, the rule ironically allows the denial of health care 
benefits for injuries sustained while participating in such 
recreational activities. If I could explain that again, you can't deny 
coverage, but you can deny benefits, which obviously makes no sense.
  Accordingly, the rule in its current form will allow insurance 
companies to treat health care benefits coverage arbitrarily and 
capriciously. Under the current rule, a plan could for example deny 
coverage for someone who has broken an arm through skiing or riding a 
motorcycle but would cover someone who sustained a similar injury from 
drinking and driving. What is worse is that a person might not even 
know that their health care coverage was even subject to such 
limitations until after they were actually injured.
  So, Mr. Speaker, this is an important consumer protection for 
millions of Americans who participate in recreational activities every 
day by providing greater transparency for plan participants. When we 
enacted the rule in 1996, we did not intend that people would be 
allowed to purchase health insurance only to find out after the fact 
that they had no coverage for an injury resulting from a common 
recreational activity. This bill simply clarifies that point.
  I want to thank Mr. Stupak and Dr. Burgess who have worked very hard 
on this legislation. I urge my colleagues on both sides of the aisle to 
support its adoption.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I thank the chairman of the subcommittee 
for bringing the bill to the floor tonight.
  This is an important bill, an important bill to me and an important 
bill to Mr. Stupak of Michigan. We've worked on this for a number of 
years through a number of sessions of Congress. In January 2001, the 
Department of Labor, the Internal Revenue Service and the Health Care 
Financing Administration, as it was then known, issued a rule in 
accordance to the Health Insurance Portability and Accountability Act 
of 1996 that was designed to guard against discrimination in coverage 
in the group health market. While addressing the issue of 
discrimination based upon participation in certain activities, these 
rules allowed continued health plan nonpayment based upon the source of 
an injury. This resulted in a situation where some people who have paid 
the premiums and believed they would be covered by their plans were 
actually responsible for paying for their own medical treatment because 
the exclusions were either unclear or very, very broad.
  The lack of clarity underlying these exclusions has created a 
confusing situation for individuals that may ride a motorcycle, might 
ride on horseback, might operate a snowmobile or participate in other 
activities that could result in an injury. Millions of Americans enjoy 
these activities safely every year within the framework of State laws 
and utilizing proper safety precautions. Earlier last year Congressman 
Stupak and I introduced H.R. 1076 to restore fairness and equity to the 
situation.
  In response to concerns raised during discussions on this bill, the 
House Energy and Commerce staff, my staff and Mr. Stupak's staff have 
all worked together in a bipartisan manner to address certain areas of 
concern. As a result of these conversations in negotiations, we have 
reintroduced our original legislation to encapsulate the agreed-to 
principles.
  H.R. 6908, the Health Insurance Source of Injury Clarification Act 
will, number one, require any limitations and restrictions on health 
plan benefits be spelled out, that they be explicit, that they be 
clear; number two, require that they be disclosed to the sponsor of the 
group health plan in advance of the point of sale of the group health 
plan; and, thirdly, require that the issuer of the health insurance 
coverage make available to participants and beneficiaries in an easily 
understandable manner a description of the limitations and restrictions 
upon their enrollment.
  This legislation is supported by a number of groups. The American 
Motorcyclist Association has been very supportive and very vocal in 
their support of this legislation, and I certainly appreciate their 
efforts in advocating for an issue that is very important to them, 
likewise the Motorcycle Riders Foundation. In addition, the American 
Council of Snowmobile Association, the American Horse Council, the 
American Recreational Coalition, American Trails, Americans for 
Responsible Recreational Access, the Blue Ribbon Coalition, the 
International Mountain Bicycling Association, the National Ski Areas 
Association, the Specialty Vehicle Industry Council, the Sporting Goods 
Manufacturing Association, the Washington Road Riders Association, and 
many others support this legislation.
  Mr. Speaker, again, this is a culmination of many, many months and 
indeed years of work on the Energy and Commerce Committee. Again I want 
to congratulate the cosponsor of the bill, Mr. Stupak of Michigan, and 
thank the chairman and the ranking member of the subcommittee for 
allowing this bill to come forward this evening.
  Mr. DINGELL. Mr. Speaker, I am pleased to support H.R. 6908, a bill 
introduced by Representatives Bart Stupak and Michael Burgess. H.R. 
6908 represents a compromise that achieves everyone's goals and is 
acceptable to all. As a result, the Committee on Energy and Commerce 
favorably reported the bill last week.
  H.R. 6908 requires transparency in healthcare benefits. An insurer is 
required to explicitly and clearly state any restrictions and 
limitations on benefits.
  You would not buy a car without knowing if it was new or used. Why 
should you buy health insurance without knowing whether the benefits 
you may need are included?
  This bill does not change what benefits an insurer provides. It 
merely requires that restrictions be transparent to the consumer. 
Specifically, this bill requires: (1) that any limitations on benefits 
be explicit and clear; (2) that they be disclosed to plan sponsors in 
advance of

[[Page H8668]]

the point of sale; and (3) that they be disclosed to participants and 
beneficiaries in a manner that is easily understandable in advance of 
enrollment and after enrollment.
  This is a commonsense bill, and it is surprising we have not required 
such transparency before. I urge my fellow colleagues to support 
passage of H.R. 6908.
  Mr. STUPAK. Mr. Speaker, this legislation does one simple thing--it 
requires health insurance companies to be up front and honest with 
their policyholders when they place limitations and restrictions on 
benefits prior to selling them an insurance policy.
  Currently, the way insurance regulations are set, many Americans are 
unaware that their health insurance may not cover injuries resulting 
from certain recreational activities because their policy is unclear or 
very broad.
  This lack of clarity has created a confusing situation for 
individuals that may ride motorcycles, horses, snowmobiles, or 
participate in other recreational activities.
  While millions of Americans enjoy these activities safely every year, 
when an individual is injured, they often find that their insurance 
will not cover their medical expenses until it is too late.
  H.R. 6908 would require that any limitations and restrictions on 
insurance benefits be explicit and clear. Insurance companies would be 
required to make available to participants and beneficiaries in an 
easily understandable manner a description of the limitations and 
restrictions included in the policy.
  By passing this straightforward legislation, we will protect our 
constituents that ride motorcycles, horses, snowmobiles, or participate 
in other recreational activities from being caught by surprise when 
they thought that their policy covered any possible injuries from their 
accident.
  I encourage all of my colleagues to vote in support of this 
legislation.
  I want to thank Congressman Burgess for his work on this legislation 
as well as Chairmen Dingell and Barton.
  I also want to thank Bridgett Taylor, Ryan Long, and Josh Martin with 
the Committee staff and Erika Orloff of my personal staff for their 
hard work on this legislation.
  Mr. BURGESS. Seeing no other speakers on my side, I yield back the 
balance of my time.
  Mr. PALLONE. Mr. Speaker, I have no further requests for time, and I 
would urge passage of this bill.
  I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 6908, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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