I

104TH CONGRESS

1ST SESSION H. R. 1012

To require equal coverage under a health plan for all children under the

age of 27 of an individual who enrolls in the plan under a family

class of enrollment.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 22, 1995

Mr. BAKER of California (for himself, Mr. LATOURETTE, and Mr. MILLER of

Florida) introduced the following bill; which was referred to the Committee on Commerce and, in addition, to the Committees on Economic and

Educational Opportunities and the Judiciary, 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 require equal coverage under a health plan for all children

under the age of 27 of an individual who enrolls in

the plan under a family class of enrollment.

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 ‘‘Family Health Care

5 Coverage Act’’.
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1 SEC. 2. FAMILY COVERAGE OF CHILDREN.

2 (a) IN GENERAL.—In the case of an individual en3 rolled in a health plan under a family class of enrollment,

4 the carrier providing the plan, or the plan sponsor spon5 soring or maintaining the plan, shall offer and provide

6 equal coverage under the plan to any child of the individ7 ual, if the child elects to receive coverage pursuant to such

8 family enrollment.

9 (b) DEFINITIONS.—For purposes of this section:

10 (1) CARRIER.—The term ‘‘carrier’’ means a li11 censed insurance company, a hospital or medical

12 service corporation (including an existing Blue Cross

13 or Blue Shield organization, within the meaning of

14 section 833(c)(2) of the Internal Revenue Code of

15 1986), a health maintenance organization, or any

16 other entity (other than a plan sponsor) licensed or

17 certified by a State to provide health insurance or

18 health benefits.

19 (2) CHILD.—

20 (A) IN GENERAL.—The term ‘‘child’’

21 means an individual who—

22 (i) is less than 27 years of age;

23 (ii) has never been married;

24 (iii) has no dependents; and

25 (iv) has a parent-child relationship

26 with another individual who is eligible to
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1 enroll in a health plan under a family class

2 of enrollment.

3 (B) APPLICATION OF STATE LAW.—Deter4 mination of whether a child has a parent-child

5 relationship with another individual shall be

6 made in accordance with applicable State law.

7 (3) FAMILY CLASS OF ENROLLMENT.—The

8 terms ‘‘family class of enrollment’’ and ‘‘family en9 rollment’’ mean enrollment in a health plan under a

10 class of enrollment that provides coverage for—

11 (A) an unmarried individual and 1 or more

12 children; or

13 (B) a married couple and 1 or more chil14 dren.

15 (4) GROUP HEALTH PLAN.—The term ‘‘group

16 health plan’’ means an employee welfare benefit plan

17 (as defined in section 3(1) of the Employee Retire18 ment Income Security Act of 1974) providing medi19 cal care (as defined in section 213(d) of the Internal

20 Revenue Code of 1986) to participants or bene21 ficiaries (as defined in section 3 of the Employee Re22 tirement Income Security Act of 1974) directly or

23 through insurance, reimbursement, or otherwise.

24 (5) HEALTH PLAN.—The term ‘‘health plan’’

25 means—
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1 (A) any contract of health insurance, in2 cluding any hospital or medical service policy or

3 certificate, hospital or medical service plan con4 tract, or health maintenance organization group

5 contract, that is provided by a carrier; or

6 (B) a group health plan, an employee wel7 fare benefit plan, a multiple employer welfare

8 arrangement, or other arrangement insofar as

9 the plan or arrangement provides health bene10 fits and is funded in a manner other than

11 through the purchase of one or more policies or

12 contracts described in subparagraph (A).

13 (6) PLAN SPONSOR.—The term ‘‘plan sponsor’’

14 means—

15 (A) a plan sponsor described in section

16 3(16)(B)(iii) of Employee Retirement Income

17 Security Act of 1974, but only with respect to

18 a group health plan that is maintained by the

19 sponsor;

20 (B) an employer of an employee covered

21 under a health plan that is a multiple employer

22 welfare arrangement (as defined in section

23 3(40) of the Employee Retirement Income Se24 curity Act); or
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1 (C) an employee organization that spon2 sors such a health plan.

3 SEC. 3. CIVIL MONEY PENALTY.

4 (a) VIOLATION.—Any individual who, or entity that,

5 the Secretary of Health and Human Services determines

6 has failed to comply with section 1 shall be subject, in

7 addition to any other penalties that may be prescribed by

8 law, to a civil money penalty of not more than $500 for

9 each such violation.

10 (b) PROCEDURES FOR IMPOSITION OF PENALTIES.—

11 The provisions of section 1128A of the Social Security Act

12 (other than subsections (a) and (b) and the second sen13 tence of subsection (f)) shall apply to the imposition of

14 a civil monetary penalty under this section in the same

15 manner as such provisions apply with respect to the impo16 sition of a penalty under section 1128A of such Act.

17 SEC. 4. INAPPLICABILITY OF MCCARRAN-FERGUSON ACT.

18 For purposes of section 2(b) of the Act of March 9,

19 1945 (15 U.S.C. 1012(b); commonly known as the

20 McCarran-Ferguson Act), this Act shall be considered to

21 specifically relate to the business of insurance.

22 SEC. 5. REGULATIONS.

23 The Secretary of Health and Human Services may

24 issue regulations to carry out this Act.

Æ