[Congressional Record (Bound Edition), Volume 155 (2009), Part 7]
[House]
[Pages 9083-9084]
[From the U.S. Government Publishing Office, www.gpo.gov]




HEALTH INSURANCE RESTRICTIONS AND LIMITATIONS CLARIFICATION ACT OF 2009

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1253) 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.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1253

       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 2009''.

     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 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 section 
     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 Louisiana (Mr. Scalise) 
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 within which to revise and extend their 
remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. I include for the Congressional Record an exchange of 
letters on this bill between the chairmen of the Committee on Energy 
and Commerce and the Committee on Education and Labor.

                             Committee on Education and labor,

                                         House of Representatives,
                                   Washington, DC, March 25, 2009.
     Hon. Henry A. Waxman,
     Chairman, Committee on Energy and Commerce, Washington, DC.
       Dear Chairman Waxman: I am writing to confirm our mutual 
     understanding regarding consideration of H.R. 1253, the 
     Health Insurance Restrictions and Limitations Clarification 
     Act of 2009. As you know, this bill was referred to the 
     Committee on Education and Labor which has a jurisdictional 
     interest in several provisions in the bill.
       Given the importance of moving this bill forward promptly, 
     I do not intend to exercise this Committee's jurisdiction by 
     conducting further proceedings on H.R. 1253. I do so, 
     however, only with the understanding that this procedural 
     route should not be construed to prejudice this Committee's 
     jurisdictional interests and prerogatives on this or similar 
     legislation and will not be considered as precedent for 
     consideration of matters of jurisdictional interest to the 
     Committee on Education and Labor in the future. In addition, 
     should this bill or similar legislation be considered in a 
     conference with the Senate, I would expect members of the 
     Committee on Education and Labor to be appointed to the 
     conference committee.
       Finally, I ask that you include a copy of our exchange of 
     letters be included in the Congressional Record during the 
     consideration of this bill. If you have any questions 
     regarding this matter, please do not hesitate to call me. I 
     thank you for your consideration.
           Sincerely,
                                                    George Miller,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                   Washington, DC, March 26, 2009.
     Hon. George Miller,
     Chairman, House Committee on Education and Labor, Washington, 
         DC.
       Dear Chairman Miller: Thank you for your letter regarding 
     H.R. 1253, the ``Health Insurance Restrictions and 
     Limitations Clarification Act of 2009.'' The letter noted 
     that certain provisions of the bill are within the 
     jurisdiction of the Committee on Education and Labor under 
     rule X of the Rules of the House.
       The Committee on Energy and Commerce recognizes the 
     jurisdictional interest of the Committee on Education and 
     Labor in these provisions. We appreciate your agreement to 
     forgo action on the bill, and I concur that the agreement 
     does not in any way prejudice the Committee on Education and 
     Labor with respect to the appointment of conferees or its 
     jurisdictional prerogatives on this bill or similar 
     legislation in the future.
       I will include our letters in the Congressional Record 
     during consideration of the bill on the House floor. Again I 
     appreciate your cooperation regarding this important 
     legislation.
           Sincerely,
                                                  Henry A. Waxman,
                                                         Chairman.

  Mr. PALLONE. I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 1253, the Health Insurance 
Restrictions and Limitations Clarification Act.
  This bill amends the Employee Retirement Income Security Act, the 
Public Health Services Act, and the Internal Revenue Code to require 
that

[[Page 9084]]

limitations on benefits in group health plans are explicit and 
disclosed to the plan's sponsor, and that that plan's sponsor disclose 
those limitations to the plan participants and beneficiaries in a 
timely manner.
  This legislation would ensure that plan beneficiaries who engage in 
activities such as riding motorcycles, horses, or snowmobiles, or any 
other legal activity that may result in injury, understand if their 
health plan won't cover those injuries. I would like to thank my 
colleagues, both Dr. Burgess as well Mr. Stupak, for their work on this 
issue. I ask my colleagues to support the bill.
  I reserve the balance of my time.
  Mr. SCALISE. Mr. Speaker, I rise in support of H.R. 1253, the Health 
Insurance Restrictions and Limitations Clarification Act of 2009.
  This bill will allow purchasers of health insurance to better 
understand what they are buying. At its core, this bill is about 
transparency for the consumer. And that is a good thing.
  This bill does not in any way alter current insurance requirements or 
limitations. This bill merely says that if an insurer wants to restrict 
or limit benefits, it must inform their enrollee prior to enrollment 
that it may so restrict or limit benefits.
  I wish to commend Congressmen Burgess and Stupak for their work on 
this bill. Mr. Speaker, I urge Members to support this legislation.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I have no speakers, but I believe that my 
colleague from Louisiana does.
  Mr. SCALISE. Mr. Speaker, I yield such time as he may consume to Mr. 
Burgess of Texas.
  Mr. BURGESS. I thank the gentleman for yielding.
  Mr. Speaker, in January 2001, the Department of Labor, the Internal 
Revenue Service, and the Health Care Finance Administration issued a 
rule in accordance with the Health Insurance Portability and 
Accountability Act, better known as HIPAA, 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 discrimination in 
the form of nonpayment based upon the source of the injury.
  So, in other words, you could have an employer-sponsored health 
insurance, which many of us do, have your premiums deducted from your 
paycheck, and yet be responsible for paying your own medical treatment 
if you were harmed. Trip and fall at home, no problem. Trip and fall 
while skiing on vacation with the family, and you get the bill. This is 
simply unfair.
  People are led to believe that care for a broken arm, for example, is 
the same regardless of how the injury happened, but in fact that is not 
the case.
  The lack of clarity underlying these exclusions has created a 
confusing situation for individuals that may ride motorcycles, horses, 
snowmobiles, or participate in other activities that could result in an 
injury. Millions of American enjoy these activities safely every year 
within the framework of State laws and utilizing proper safety 
precautions. The bill we are voting on today will take away the 
ambiguity and make certain that people are aware of any such 
restrictions in their coverage.
  Again, this is not a bill that would require anything new to be done 
other than people be told up front and in plain language if there are 
limitations on their health care policy.
  We are going to stand up and shine the light on these exclusions so 
that Americans will not be caught off guard by exclusions buried deep 
within an insurance plan.
  H.R. 1253, the Health Insurance Source of Injury Clarification Act, 
is identical to legislation passed by the House last session and will, 
first, require any limitations and restrictions on health plan benefits 
be explicit and clear; second, require that they be disclosed to the 
sponsor of the group health plan in advance of the sale; and, thirdly, 
require that the issuer in an easy-to-understand way provide 
participants and beneficiaries a description of the limitations and 
restrictions as soon as they enroll.
  For those who are concerned about the potential cost of the bill, I 
do have a score from the Congressional Budget Office. Their cost 
estimate is that H.R. 1253 would have no significant impact upon the 
Federal budget. Further, they go on to say that making the information 
more easily understood would generate only negligible cost. H.R. 1253 
contains no intergovernmental mandates as defined.
  Mr. Speaker, I again want to thank Representative Bart Stupak from 
Michigan for his steadfast help in this bill. It has been a long 
process to get this passed. I certainly want to thank Chairman Waxman 
for his participation, and a special recognition to former Chairman 
John Dingell who helped us get this bill passed in the last Congress. 
We passed it late in the last Congress; the Senate did not get the work 
finished. We are passing it early in this Congress to allow the other 
body ample time to see this bill become law.
  Mr. SCALISE. Mr. Speaker, I yield back the balance of my time.
  Mr. STUPAK. Mr. Speaker, this legislation does one simple thing, Mr. 
Speaker--it requires health insurance companies to be upfront and 
honest with their policy holders 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.
  H.R. 1253 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 Chairman Waxman, Dingell and Barton.
  Mr. PALLONE. I yield back the balance of my time and urge passage.
  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. 1253.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BROUN of Georgia. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________