I

104TH CONGRESS

2D SESSION H. R. 3145

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 21, 1996

Mrs. MORELLA (for herself and Mr. SCHUMER) 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 of 1996’’.
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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 ‘‘An insurer may not deny or cancel health insurance,

14 or vary the terms and conditions of health insurance—

15 ‘‘(1) to an individual on the basis that the indi16 vidual or family member—

17 ‘‘(A) is, has been, or may be the subject of

18 an act of domestic violence;

19 ‘‘(B) has had prior injuries that resulted

20 from an act of domestic violence;

21 ‘‘(C) seeks, has sought, or should have

22 sought medical or psychological treatment for

23 protection against an act of domestic violence;

24 or
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1 ‘‘(D) seeks, has sought, or should have

2 sought shelter from an act of domestic violence;

3 or

4 ‘‘(2) to or for a group or employer on the basis

5 that the group includes or the employer employs, or

6 provides or subsidizes insurance for, an individual

7 described in paragraph (1).

8 ‘‘SEC. 2702. LIMITATION ON DISCLOSURE OF INFORMATION.

9 ‘‘(a) PROHIBITION.—Except as provided in para10 graph (2), regardless of the manner in which information

11 was received, an insurer may not disclose or be compelled

12 (by subpoena or any other means) to disclose information

13 concerning the status of an individual as a victim of do14 mestic violence (including the relationship of a medical

15 condition to an incident or pattern of domestic violence),

16 or the status of an individual as a family member, em17 ployer, associate, or person in a relationship with an indi18 vidual who is the victim of domestic violence, unless the

19 individual involved provides a written authorization.

20 ‘‘(b) EXCEPTION.—Notwithstanding paragraph (1),

21 information concerning the abuse status of an individual

22 may be disclosed if such disclosure—

23 ‘‘(1) is required under the specific order of a

24 Federal or State court; or
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1 ‘‘(2) is required by the State Insurance Com2 missioner.

3 ‘‘SEC. 2703. ESTABLISHMENT OF STANDARDS.

4 ‘‘(a) ROLE OF NATIONAL ASSOCIATION OF INSUR5 ANCE COMMISSIONERS.—

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

7 the National Association of Insurance Commis8 sioners to develop, in consultation with nonprofit do9 mestic violence victim advocacy organizations, within

10 9 months after the date of the enactment of this

11 title, model standards that incorporate the limita12 tions on underwriting set forth in section 2701, and

13 provide procedures for enforcement for such provi14 sions, including a private right of action.

15 ‘‘(2) REVIEW OF STANDARDS.—If the Associa16 tion develops recommended regulations specifying

17 the standards within the period, the Secretary shall

18 review the standards. The review shall be completed

19 within 90 days after the date the regulations are de20 veloped. Unless the Secretary determines within the

21 period that such standards do not meet the require22 ments, such standards shall serve as the standards

23 under this title, with such amendments as the Sec24 retary determines to be necessary.
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1 ‘‘(b) CONTINGENCY.—If the Association does not de2 velop the model regulations within the 9 month period be3 ginning on the date of the enactment of this title, or the

4 Secretary determines that the regulations do not specify

5 standards that meet the requirements described in sub6 section (a), the Secretary shall specify, within 15 months

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

8 carry out the requirements.

9 ‘‘(c) APPLICATION OF STANDARDS.—

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

11 the Secretary, by the deadline specified in paragraph

12 (2), a report on actions the State is taking to imple13 ment and enforce the standards established under

14 this section with respect to insurers and health in15 surance coverage offered or renewed not later than

16 such deadline.

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

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

19 later than 1 year after the date that standards are

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

21 the failure of the Association to develop timely model

22 regulations, under subsection (b).

23 ‘‘(d) FEDERAL ROLE.—

24 ‘‘(1) NOTICE OF DEFICIENCY.—If the Secretary

25 determines that a State has failed to submit a report
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1 by the deadline specified by subsection (c), or finds

2 that the State has not implemented and provided

3 adequate enforcement of the standards established

4 under subsection (a) or (b), the Secretary shall no5 tify the State and provide the State a period of 60

6 days in which to submit the report.

7 ‘‘(2) IMPLEMENTATION OF ALTERNATIVE EN8 FORCEMENT MECHANISM.—

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

10 period, the Secretary finds that such a failure

11 has not been corrected, the Secretary shall

12 within 30 days provide for a mechanism for the

13 implementation and enforcement of such stand14 ards in the State as the Secretary determines to

15 be appropriate.

16 ‘‘(B) CIVIL PENALTY.—Under any imple17 mentation and enforcement mechanism estab18 lished by the Secretary pursuant to this para19 graph, the Secretary shall have the authority to

20 impose on an insurer a civil monetary penalty

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

22 which such insurer violates the requirements

23 described in section 2701, or the standards de24 veloped under this section. Liability for such

25 penalty shall begin to accrue on the 30th day
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1 after the Secretary has provided such insurer

2 with notice of its noncompliance, if the insurer

3 has failed to correct the deficiency by such date.

4 ‘‘(C) EFFECTIVE PERIOD.—Any such im5 plementation and enforcement mechanism es6 tablished by the Secretary shall take effect with

7 respect to insurers, and health insurance cov8 erage offered or renewed, on or after 3 months

9 after the date of the Secretary’s finding under

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

11 finds that such a failure has been corrected.

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

13 ‘‘(A) IN GENERAL.—Any individual

14 aggrieved as a result of conduct prohibited

15 by section 2701 may bring a civil action in

16 the appropriate United States district

17 court against the insurer.

18 ‘‘(B) RELIEF.—Upon proof of such

19 conduct by a preponderance of the evi20 dence, the insurer shall be subject to a civil

21 penalty that may include temporary, pre22 liminary, or permanent injunctive relief

23 and compensatory and punitive damages,

24 as well as the costs of suit and reasonable

25 fees for the aggrieved individual’s attor-
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1 neys. With respect to compensatory dam2 ages, the aggrieved individual may elect, at

3 any time prior to the rendering of final

4 judgment, to recover in lieu of actual dam5 ages, an award of statutory damages in the

6 amount of $5,000 for each violation.

7 ‘‘SEC. 2704. APPLICATION TO GROUP HEALTH PLANS AND

8 ENFORCEMENT.

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

10 prohibitions in section 2701 and the standards developed

11 under section 2702 shall apply to group health plans pro12 viding health coverage in the same manner as they apply

13 to insurers providing health insurance coverage. The pen14 alty described in section 2702(d)(2)(B) may be imposed

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

16 not in compliance with the requirements of sections 2701

17 and 2702.

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

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

20 to—

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

22 Human Services is deemed to be a reference to the

23 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. 2705. DEFINITIONS.

16 ‘‘For purposes of this title:

17 ‘‘(1) ACT OF DOMESTIC VIOLENCE.—The term

18 ‘act of domestic violence’ means the occurrence of

19 one or more of the following acts between family or

20 household members, current or former sexual or inti21 mate partners, or persons sharing biological parent22 hood—

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

24 knowingly, or recklessly causing bodily injury,
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1 rape, or sexual abuse as such term is defined in

2 section 2242 of title 18, United States Code;

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

4 individual in reasonable fear of imminent seri5 ous bodily injury;

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

7 ‘‘(D) physically or sexually abusing minor

8 children.

9 ‘‘(2) ASSOCIATION.—The term ‘Association’

10 means the National Association of Insurance Com11 missioners.

12 ‘‘(3) INSURER.—

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

14 means a health benefit plan or a health care

15 provider that conducts activities related to the

16 protection of public health.

17 ‘‘(B) HEALTH BENEFIT PLAN.—The term

18 ‘health benefit plan’ means any public or pri19 vate entity or program that provides for pay20 ments for health care, including—

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

22 section 607 of the Employee Retirement

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

24 1167)) or a multiple employer welfare ar25 rangement (as defined in section 3(40) of
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1 such Act) that provides health benefits;

2 and

3 ‘‘(ii) any other health insurance ar4 rangement, including any arrangement

5 consisting of a hospital or medical expense

6 incurred policy or certificate, hospital or

7 medical service plan contract, or health

8 maintenance organization subscriber con9 tract.

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

11 ‘health care provider’ means a provider of serv12 ices (as defined in section 1861(u) of the Social

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

14 a supplier, or any other person furnishing

15 health care, including a Federal or State pro16 gram that provides directly for the provision of

17 health care to beneficiaries.’’.

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