A bill to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prevent group and individual health insurance coverage and group health plans from seeking to recover more than th

8 Pages·2000·0.32 MB·English

by  United States. Congress. House

Cii5Libr3r>'
C2-07-13
720CSocu:1tyBlvd.
Eialtlri-.orS; Maryier.ci 21244
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106thCONGRESS fT OC%W^gO^WD^
2DSESSION rl* I
ToamendthePublicHealth ServiceAct,theEmployeeRetirement Income
SecurityActof1974,andtheInternalRevenueCodeof1986toprevent
groupandindividual healthinsurancecoverageandgrouphealth plans
from seekhigtorecovermorethan their costs m casesofthird party
recoveries.
IN THE HOUSE OF REPRESENTATIVES
Februaey29,2000
Mr.Wiseintroducedthefollowingbill;whichwasreferredtotheCommittee's
onCommerce,andinadditiontotheCommitteesonEducationandthe
Workforce,andWaysandMeans,foraperiodtobesubsequentlydeter-
minedbytheSpeaker,uieachcaseforconsiderationofsuchpro\'isions
asfallwithinthejurisdictionofthecommitteeconcerned
A
BILL
To amend the Public Health SemeeAct, the Employee Re-
tirementIncome SecurityAct of 1974, and the Internal
Revenue Code of 1986 to prevent group and individual
health insurance coverage and group health plans from
seeking to recover more than their costs in cases of
thirdpartyrecoveries.
1 BeitenactedhytheSenateandHomeofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassemUed,
/
2
1 SECTION1.SHORTTITLE.
2 ThisActmaybecitedasthe "HealthInsuranceLi-
3 abilityRecoverj^ProtectionActof2000".
4 SEC.2.PATIENTPROTECTION INCASE OFTHIRD PARTY
5 RECOVERIES.
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6 (a)GroupHealthPlans
7 (1) Public health ser\^ce act amend-
8 MENTS.—Subpart 2 ofpartAoftitleXXVH ofthe
9 Public Health ServiceAct is amendedby adding at
10 theendthefollowingnewsection:
11 "SEC. 2707. STANDARD RELATING TO PATIENT PROTEC-
12 TIONINCASEOFTHIRDPARTYRECOVERIES.
13 "(a) Requireaient—A group health plan, and a
14 health insurance issuer offering group health insurance
15 coverage,maynotrecover(orseektorecover)fromapar-
16 ticipant or beneficiarymore than the amounts expended
17 bytheplanorissueronbehalfoftheparticipantorbene-
18 ficiaiyinthecaseofamountsrecoveredbysuchapartici-
19 pantorbeneficiary'asaresultofasettlementorjudgment
20 inahabilityorotheraction.
—
21 "(b) Notice. ^Agroup healthplanunderthis part
22 shall comply with the notice requirement under section
23 714(b) oftheEmployee RetirementIncome SecurityAct
24 of 1974yvith respect to the requirements ofthis section
25 asifsuchsectionapphedtosuchplan.".
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1 (2) ERISA AMENDMENTS.—(A) Subpart B of
2 part 7 ofsubtitle B oftitle I ofthe Employee Re-
3 tirementIncomeSecurityActof1974isamendedby
4 addingattheendthefollowingnewsection:
5 "SEC.714.STANDARDRELATINGTOPATIENTPROTECTION
6 INCASEOFTHIRDPARTYRECOVERIES.
—
7 "(a) Requirement. ^A group health plan, and a
8 health insurance issuer offering group health insurance
9 coverage,maynotrecover(orseektorecover)fromapar-
10 ticipant orbeneficiaiy more than the amounts expended
11 bytheplanorissueronbehalfoftheparticipantorbene-
12 ficiarvinthecaseofamountsrecoveredbysuchapartici-
13 pantorbeneficiary^asaresultofasettlementorjudgment
14 inahabilityorotheraction.
15 "(b) Notice Under Group Health Plan.—The
16 impositionoftherequirementofthissectionshallbetreat-
17 edasamaterialmodificationinthetermsoftheplande-
18 scribedinsection 102(a)(1),forpurposesofassuringno-
19 ticeofsuchrequirementsundertheplan; exceptthatthe
20 summary' description required to be provided under the
21 last sentence of section 104(b)(1) with respect to such
22 modification shallbepro\idedbynot later than 60 days
23 after the first day of the first plan year in which such
24 requirementapply.".
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4
1 (B) Section 732(a) of such Act (29 U.S.C.
2 1191a(a)) is amendedbystriking"section711" and
3 inserting"sections711and714".
4 (C) The table ofcontents in section 1 of such
5 Act is amendedbyinserting after the item relating
6 tosection713thefollo^gnewitem:
"Sec.714.Standardrelatingtopatient{)rotectionincaseofthirdpartyrecov-
eries.".
7 (3) Internal revenue code miend-
8 MENTS.
—
9 (A) In GENERAL. Subchapter B ofchap-
10 ter 100 ofthe Internal Revenue Code of 1986
11 isamended
12 (i) in the table ofsections, byinsert-
13 ingafterthe item relatingto section 9812
14 thefollowingnewitem:
"Sec. 9813.Standardrelatingto patient i)roteetionin easeof
thirdpartyrecoveries.";and
15 (ii)byinsertingaftersection9812 the
16 following:
17 "SEC. 9813. STANDARD RELATING TO PATIENT PROTEC-
18 TIONINCASEOFTHIRDPARTYRECOVERIES.
19 "Agrouphealthplanmaynotrecover(orseektore-
20 cover) from a participant or beneficiary more than the
21 amountsexpendedbytheplanonbehalfoftheparticipant
22 or beneficiary in the case ofamounts recoveredby such
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1 aparticipantorbeneficiaryasaresultofasettlementor
2 judgmentinaliabilityorotheraction.".
—
3 (B) Conforming amendment. Section
4 4980D(d)(l) ofsuchCodeisamendedbystrik-
5 ing "section 9811" and inserting "sections
6 9811and9813".
—
7 (b) Individual Health Insurance. Part B of
8 titleXXVIIofthePublicHealthServiceActis amended
9 byinsertingaftersection2752 thefollowingnewsection:
10 «SEC.2753.STANDARDRELATINGPATIENTPROTECTIONIN
11 CASEOFTHIRDPARTYRECOVERIES.
—
12 "(a) In General. The provisions of section
13 2707(a) shall applyto health insurance coverage offered
14 by a health insurance issuer in the indi^idual market in
15 the same manner as they applyto health uisurance cov-
16 erage offeredby a health insurance issuer in connection
17 withagrouphealthplaninthesmallorlargegroupmar-
is ket.
—
19 "(b) Notice. healthinsurance issuerunderthis
20 part shall complywiththenoticerequirementunder sec-
21 tion 714(b) oftheEmployeeRetirementIncome Security
22 Act of1974withrespect totherequirementsreferredto
23 insubsection(a) asifsuchsectionappliedto suchissuer
24 andsuchissuerwereagrouphealthplan.".
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25 (c)EffectiveDates.
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1 (1) Group health plans and group
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2 HEALTH insurance COVERAGE. Subject to para-
3 ^aph (3), the amendments made by subsection (a)
4 apply with respect to group health plans for plan
5 yearsbeginningonorafterJanuary1,2001.
6 (2) iNDIVroUAL HEALTH INSURANCE COV-
—
7 ERAGE. The amendment made by subsection (b)
8 appheswithrespecttohealthinsurancecoverage of-
9 fered, sold, issued, renewed, ineffect, oroperatedin
10 theindividualmarketonoraftersuchdate.
11 (3) Collective bargaining exception.—In
12 thecaseofagrouphealthplanmaintainedpursuant
13 to 1 or more collective bargaining agreements be-
14 tu'een employee representatives and 1 or more em-
15 ployers ratifiedbeforethe date ofenactment'ofthis
16 Act, the amendments made subsection (a) shall not
17 apply to plan years beginningbefore the later of
18 (A) the date on which the last collective
19 bargaining agreements relatingto theplanter-
20 minates (determinedwithout regardto any ex-
21 tension thereof agreed to after the date of en-
22 actmentofthisAct),or
23 (B) Januar}^1,2002.
24 Forpurposesofsubparagraph (A), anyplanamend-
25 ment made pursuant to a collective bargaining
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CiISUbrary
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1 agreement relating to the plan which amends the
2 plan solelyto conform to anyrequirement addedby
3 subsection (a) shall notbe treated as a termination
4 ofsuchcollectivebargainingagreement.
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5 (d) Coordination ofAdministration. The See-
6 retary ofLabor, the Secretary ofthe Treasury, and the
7 Secretary of Health and Human Services shall ensure,
8 through the execution ofaninteragencymemorandum of
9 understandingamongsuchSecretaries,that
10 (1) regulations, ruhngs, and interpretations
11 issuedbysuch Secretariesrelatingtothesamemat-
12 teroverwhichtwoormoresuchSecretarieshavere-
13 sponsibihtyunderthep^o^isionsofthisAct (andthe
14 amendments made thereby) are administered so as
15 tohavethesameeffectatalltimes;and
16 (2) coordinationofpohciesrelatingtoenforcing
17 the same requirements through such Secretaries in
18 order to have a coordinated enforcement strateg}^
19 that avoids duphcation of enforcement efforts and
20 assignsprioritiesinenforcement.
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