I

104TH CONGRESS

1ST SESSION H. R. 1201

To amend the Public Health Service Act to prohibit health insurance

discrimination with respect to victims of domestic violence.

IN THE HOUSE OF REPRESENTATIVES

MARCH 10, 1995

Mr. WYDEN (for himself, Mr. SCHUMER, and Mrs. MORELLA) introduced the

following bill; which was referred to the Committee on Commerce, and

in addition to the Committee on Economic and Educational Opportunities, 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 amend the Public Health Service Act to prohibit health

insurance discrimination with respect to victims of domestic violence.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Insurance Protection

5 for Victims of Domestic Violence Act’’.
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1 SEC. 2. PROHIBITION OF HEALTH INSURANCE DISCRIMINA2 TION WITH RESPECT TO VICTIMS OF DOMES3 TIC VIOLENCE.

4 The Public Health Service Act (42 U.S.C. 201 et

5 seq.) is amended by adding at the end the following new

6 title:

7 ‘‘TITLE XXVII—PROHIBITION OF

8 HEALTH INSURANCE DIS9 CRIMINATION WITH RESPECT

10 TO VICTIMS OF DOMESTIC VI11 OLENCE

12 ‘‘SEC. 2701. LIMITATIONS ON UNDERWRITING.

13 ‘‘No insurer may engage in a practice that has the

14 effect of denying, canceling, or not renewing health insur15 ance coverage or health benefits, or establishing, increas16 ing, or varying the premium charged for the coverage or

17 benefits or excluding health coverage with respect to

18 health care items or services related to treatment of a con19 dition—

20 ‘‘(1) to an individual on the basis that the indi21 vidual or family member is, has been, or may be the

22 subject of abuse, has had prior injuries that resulted

23 from abuse, or seeks, has sought, or should have

24 sought medical or psychological treatment for pro25 tection against abuse, or shelter from abuse; or
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1 ‘‘(2) to or for a group or employer on the basis

2 that the group includes or the employer employs, or

3 provides or subsidizes insurance for, an individual

4 described in paragraph (1).

5 ‘‘SEC. 2702. ESTABLISHMENT OF STANDARDS.

6 ‘‘(a) ROLE OF NATIONAL ASSOCIATION OF INSUR7 ANCE COMMISSIONERS.—

8 ‘‘(1) IN GENERAL.—The Secretary shall request

9 the National Association of Insurance Commis10 sioners to develop, in consultation with nonprofit do11 mestic violence victim advocacy organizations, within

12 9 months after the date of the enactment of this

13 title, model standards that incorporate the limita14 tions on underwriting set forth in section 2701, and

15 provide procedures for enforcement for such provi16 sions, including a private right of action.

17 ‘‘(2) REVIEW OF STANDARDS.—If the Associa18 tion develops recommended regulations specifying

19 the standards within the period, the Secretary shall

20 review the standards. The review shall be completed

21 within 90 days after the date the regulations are de22 veloped. Unless the Secretary determines within the

23 period that such standards do not meet the require24 ments, such standards shall serve as the standards
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1 under this title, with such amendments as the Sec2 retary determines to be necessary.

3 ‘‘(b) CONTINGENCY.—If the Association does not de4 velop the model regulations within the 9 month period be5 ginning on the date of the enactment of this title, or the

6 Secretary determines that the regulations do not specify

7 standards that meet the requirements described in sub8 section (a), the Secretary shall specify, within 15 months

9 after the date of the enactment of this title, standards to

10 carry out the requirements.

11 ‘‘(c) APPLICATION OF STANDARDS.—

12 ‘‘(1) IN GENERAL.—Each State shall submit to

13 the Secretary, by the deadline specified in paragraph

14 (2), a report on actions the State is taking to imple15 ment and enforce the standards established under

16 this section with respect to insurers and health in17 surance coverage offered or renewed not later than

18 such deadline.

19 ‘‘(2) DEADLINE FOR REPORT.—Each State

20 shall file the report described in paragraph (1) not

21 later than 1 year after the date that standards are

22 established under subsection (a) or, in the event of

23 the failure of the Association to develop timely model

24 regulations, under subsection (b).

25 ‘‘(d) FEDERAL ROLE.—
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1 ‘‘(1) NOTICE OF DEFICIENCY.—If the Secretary

2 determines that a State has failed to submit a report

3 by the deadline specified by subsection (c), or finds

4 that the State has not implemented and provided

5 adequate enforcement of the standards established

6 under subsection (a) or (b), the Secretary shall no7 tify the State and provide the State a period of 60

8 days in which to submit the report.

9 ‘‘(2) IMPLEMENTATION OF ALTERNATIVE EN10 FORCEMENT MECHANISM.—

11 ‘‘(A) IN GENERAL.—If, after the 60-day

12 period, the Secretary finds that such a failure

13 has not been corrected, the Secretary shall

14 within 30 days provide for a mechanism for the

15 implementation and enforcement of such stand16 ards in the State as the Secretary determines to

17 be appropriate.

18 ‘‘(B) CIVIL PENALTY.—Under any imple19 mentation and enforcement mechanism estab20 lished by the Secretary pursuant to this para21 graph, the Secretary shall have the authority to

22 impose on an insurer a civil monetary penalty

23 in the amount of $10,000 for each day during

24 which such insurer violates the requirements

25 described in section 2701, or the standards de-
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1 veloped under this section. Liability for such

2 penalty shall begin to accrue on the 30th day

3 after the Secretary has provided such insurer

4 with notice of its noncompliance, if the insurer

5 has failed to correct the deficiency by such date.

6 ‘‘(C) EFFECTIVE PERIOD.—Any such im7 plementation and enforcement mechanism es8 tablished by the Secretary shall take effect with

9 respect to insurers, and health insurance cov10 erage offered or renewed, on or after 3 months

11 after the date of the Secretary’s finding under

12 paragraph (1), and until the date the Secretary

13 finds that such a failure has been corrected.

14 ‘‘(3) FEDERAL CIVIL RIGHT OF ACTION.—

15 ‘‘(A) IN GENERAL.—Any individual

16 aggrieved as a result of conduct prohibited

17 by section 2701 may bring a civil action in

18 the appropriate United States district

19 court against the insurer.

20 ‘‘(B) RELIEF.—Upon proof of such

21 conduct by a preponderance of the evi22 dence, the insurer shall be subject to a civil

23 penalty that may include temporary, pre24 liminary, or permanent injunctive relief

25 and compensatory and punitive damages,
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1 as well as the costs of suit and reasonable

2 fees for the aggrieved individual’s attor3 neys. With respect to compensatory dam4 ages, the aggrieved individual may elect, at

5 any time prior to the rendering of final

6 judgment, to recover in lieu of actual dam7 ages, an award of statutory damages in the

8 amount of $5,000 for each violation.

9 ‘‘SEC. 2703. APPLICATION TO GROUP HEALTH PLANS AND

10 ENFORCEMENT.

11 ‘‘(a) APPLICATION.—Subject to subsection (b), the

12 prohibitions in section 2701 and the standards developed

13 under section 2702 shall apply to group health plans pro14 viding health coverage in the same manner as they apply

15 to insurers providing health insurance coverage. The pen16 alty described in section 2702(d)(2)(B) may be imposed

17 by the Secretary of Labor on group health plans that are

18 not in compliance with the requirements of sections 2701

19 and 2702.

20 ‘‘(b) SUBSTITUTION OF FEDERAL OFFICIALS.—For

21 purposes of subsection (a), any reference in section 2702

22 to—

23 ‘‘(1) a State or the Secretary of Health and

24 Human Services is deemed to be a reference to the

25 Secretary of Labor; and
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1 ‘‘(2) an insurer or health insurance coverage is

2 deemed to be a reference to a group health plan and

3 health coverage, respectively.

4 ‘‘(c) ENFORCEMENT.—For purposes of part 5 of sub5 title B of title I of the Employee Retirement Income Secu6 rity Act of 1974 (29 U.S.C 1131 et seq.) the provisions

7 of this title insofar as they relate to group health plans

8 shall be deemed to be provisions of title I of such Act irre9 spective of exclusions under section 4(b) of such Act.

10 ‘‘(d) REGULATORY AUTHORITY.—With respect to the

11 regulatory authority of the Secretary of Labor under this

12 title pursuant to subsection (c), section 505 of the Em13 ployee Retirement Income Security Act of 1974 (29

14 U.S.C. 1135) shall apply.

15 ‘‘SEC. 2704. DEFINITIONS.

16 ‘‘For purposes of this title:

17 ‘‘(1) ASSOCIATION.—The term ‘Association’

18 means the National Association of Insurance Com19 missioners.

20 ‘‘(2) INSURER.—

21 ‘‘(A) IN GENERAL.—The term ‘insurer’

22 means a health benefit plan or a health care

23 provider that conducts activities related to the

24 protection of public health.
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1 ‘‘(B) HEALTH BENEFIT PLAN.—The term

2 ‘health benefit plan’ means any public or pri3 vate entity or program that provides for pay4 ments for health care, including—

5 ‘‘(i) a group health plan (as defined in

6 section 607 of the Employee Retirement

7 Income Security Act of 1974 (29 U.S.C.

8 1167)) or a multiple employer welfare ar9 rangement (as defined in section 3(40) of

10 such Act) that provides health benefits;

11 and

12 ‘‘(ii) any other health insurance ar13 rangement, including any arrangement

14 consisting of a hospital or medical expense

15 incurred policy or certificate, hospital or

16 medical service plan contract, or health

17 maintenance organization subscriber con18 tract.

19 ‘‘(C) HEALTH CARE PROVIDER.—The term

20 ‘health care provider’ means a provider of serv21 ices (as defined in section 1861(u) of the Social

22 Security Act ( 42 U.S.C. 1395u)), a physician,

23 a supplier, or any other person furnishing

24 health care, including a Federal or State pro-
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1 gram that provides directly for the provision of

2 health care to beneficiaries.

3 ‘‘(3) VICTIM OF ABUSE.—The term ‘victim of

4 abuse’ means the occurrence of one or more of the

5 following acts between family or household members,

6 current or former sexual or intimate partners, or

7 persons sharing biological parenthood—

8 ‘‘(A) attempting to cause or intentionally,

9 knowingly, or recklessly causing bodily injury,

10 rape, or sexual abuse as such term is defined in

11 section 2242 of title 18, United States Code.

12 ‘‘(B) placing, by physical menace, another

13 individual in reasonable fear of imminent seri14 ous bodily injury;

15 ‘‘(C) infliction of false imprisonment; or

16 ‘‘(D) physically or sexually abusing minor

17 children.’’.

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