I

104TH CONGRESS

2D SESSION H. R. 3030

To establish a minimum amount that may be applied as an aggregate lifetime

limit with respect to coverage under an employee health benefits plan

or a group health plan.

IN THE HOUSE OF REPRESENTATIVES

MARCH 6, 1996

Ms. ESHOO introduced the following bill; which was referred to the Committee

on Economic and Educational Opportunities, and in addition to the Committee on Commerce, 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 establish a minimum amount that may be applied as

an aggregate lifetime limit with respect to coverage under

an employee health benefits plan or a group health plan.

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 ‘‘Christopher Reeve

5 Health Insurance Reform Act of 1996’’.
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1 SEC. 2. LIMITATION ON LIFETIME AGGREGATE LIMITS FOR

2 GROUP HEALTH PLANS.

3 (a) IN GENERAL.—Except as provided in subsection

4 (b), an employee health benefit plan or a health plan is5 suer offering a group health plan may not impose an ag6 gregate dollar lifetime limit of less than $10,000,000 with

7 respect to coverage under the plan. The dollar amount

8 specified in the previous sentence shall be adjusted for in9 flation in fiscal years after the fiscal year in which this

10 section becomes effective.

11 (b) SMALL EMPLOYER EXCEPTION.—Subsection (a)

12 shall not apply to a group health plan offered to or main13 tained for employees of a single employer that employs 20

14 or fewer employees.

15 (c) RULE OF CONSTRUCTION.—Subsection (a) shall

16 not be construed as prohibiting the application by an em17 ployee health benefit plan or a health plan issuer offering

18 a group health plan of any limits, exclusions, or other

19 forms of cost containment mechanisms with respect to cov20 erage under the plan other than the aggregate limit per21 mitted under subsection (a).

22 (d) DISCLOSURE.—Any limits, exclusions, or other

23 cost containment mechanisms permitted under subsection

24 (c) shall be disclosed under section 3.

25 (e) APPLICATION OF SECTION.—This section shall

26 not apply to a health maintenance organization that meets
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1 the requirements of title XIV of the Public Health Service

2 Act.

3 (f) EFFECTIVE DATE.—This section shall become ef4 fective with respect to health plans on the date that is

5 2 years after the date of the enactment of this Act.

6 SEC. 3. DISCLOSURE OF LIMITS AND EXCLUSIONS.

7 An employee health benefit plan or a health plan is8 suer offering a group health plan shall disclose, as part

9 of its solicitation and sales materials and in a form and

10 manner that is conspicuous and understandable to a rea11 sonable individual, any limits, exclusions, or cost contain12 ment mechanisms with respect to coverage provided under

13 the plan.

14 SEC. 4. INCORPORATION OF DEFINITIONS AND OTHER

15 TERMS.

16 For purposes of this Act—

17 (1) the definitions contained in section 2 of the

18 Health Insurance Reform Act of 1996 (H.R. 2893)

19 shall apply to this Act; and

20 (2) the provisions of title II and sections 303

21 and 304 of such Health Insurance Reform Act of

22 1996 (relating to enforcement, effective dates, and

23 severability) shall apply to the provisions of sections

24 2 and 3 of this Act in the same manner as if they
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1 were parts of sections 103 and 105, respectively, of

2 such Act.

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