I

103D CONGRESS

2D SESSION H. R. 4829

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

JULY 26, 1994

Mr. BAKER of California introduced the following bill; which was referred

jointly to the Committees on Energy and Commerce, Education and

Labor, and the Judiciary

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’’.

6 SEC. 2. FAMILY COVERAGE OF CHILDREN.

7 (a) IN GENERAL.—In the case of an individual en8 rolled in a health plan under a family class of enrollment,

9 the carrier providing the plan, or the plan sponsor spon-
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1 soring or maintaining the plan, shall offer and provide

2 equal coverage under the plan to any child of the individ3 ual, if the child elects to receive coverage pursuant to such

4 family enrollment.

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

6 (1) CARRIER.—The term ‘‘carrier’’ means a li7 censed insurance company, a hospital or medical

8 service corporation (including an existing Blue Cross

9 or Blue Shield organization, within the meaning of

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

11 1986), a health maintenance organization, or any

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

13 certified by a State to provide health insurance or

14 health benefits.

15 (2) CHILD.—

16 (A) IN GENERAL.—The term ‘‘child’’

17 means an individual who—

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

19 (ii) has never been married;

20 (iii) has no dependents; and

21 (iv) has a parent-child relationship

22 with another individual who is eligible to

23 enroll in a health plan under a family class

24 of enrollment.
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1 (B) APPLICATION OF STATE LAW.—Deter2 mination of whether a child has a parent-child

3 relationship with another individual shall be

4 made in accordance with applicable State law.

5 (3) FAMILY CLASS OF ENROLLMENT.—The

6 terms ‘‘family class of enrollment’’ and ‘‘family en7 rollment’’ mean enrollment in a health plan under a

8 class of enrollment that provides coverage for—

9 (A) An unmarried individual and 1 or

10 more children; or

11 (B) A married couple and 1 or more chil12 dren.

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

14 health plan’’ means an employee welfare benefit plan

15 (as defined in section 3(1) of the Employee Retire16 ment Income Security Act of 1974) providing medi17 cal care (as defined in section 213(d) of the Internal

18 Revenue Code of 1986) to participants or bene19 ficiaries (as defined in section 3 of the Employee Re20 tirement Income Security Act of 1974) directly or

21 through insurance, reimbursement, or otherwise.

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

23 means—

24 (A) any contract of health insurance, in25 cluding any hospital or medical service policy or
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1 certificate, hospital or medical service plan con2 tract, or health maintenance organization group

3 contract, that is provided by a carrier; or

4 (B) a group health plan, an employee wel5 fare benefit plan, a multiple employer welfare

6 arrangement, or other arrangement insofar as

7 the plan or arrangement provides health bene8 fits and is funded in a manner other than

9 through the purchase of one or more policies or

10 contracts described in subparagraph (A).

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

12 means—

13 (A) a plan sponsor described in section

14 3(16)(B)(iii) of Employee Retirement Income

15 Security Act of 1974, but only with respect to

16 a group health plan that is maintained by the

17 sponsor;

18 (B) an employer of an employee covered

19 under a health plan that is a multiple employer

20 welfare arrangement (as defined in section

21 3(40) of the Employee Retirement Income Se22 curity Act); or

23 (C) an employee organization that spon24 sors such a health plan.
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1 SEC. 3. CIVIL MONEY PENALTY.

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

3 the Secretary of Health and Human Services determines

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

5 addition to any other penalties that may be prescribed by

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

7 each such violation.

8 (b) PROCEDURES FOR IMPOSITION OF PENALTIES.—

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

10 (other than subsections (a) and (b) and the second sen11 tence of subsection (f)) shall apply to the imposition of

12 a civil monetary penalty under this section in the same

13 manner as such provisions apply with respect to the impo14 sition of a penalty under section 1128A of such Act.

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

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

17 1945 (15 U.S.C. 1012(b); commonly known as the

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

19 specifically relate to the business of insurance.

20 SEC. 5. REGULATIONS.

21 The Secretary of Health and Human Services may

22 issue regulations to carry out this Act.

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