I 

111TH CONGRESS 

1ST SESSION H. R. 1085 

To impose a limitation on lifetime aggregate limits imposed by health plans. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2009 

Ms. ESHOO (for herself, Mr. ALTMIRE, Mr. LANGEVIN, Ms. SUTTON, and Mr. 

KILDEE) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Education and Labor, 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 impose a limitation on lifetime aggregate limits imposed 

by health plans. 

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 ‘‘Health Insurance Cov5 erage Protection Act’’. 

6 SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN7 COME SECURITY ACT OF 1974. 

8 (a) IN GENERAL.—Subpart B of part 7 of subtitle 

9 B of title I of the Employee Retirement Income Security 


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1 Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add2 ing at the end the following: 

3 ‘‘SEC. 715. LIMITATION ON LIFETIME AGGREGATE LIMITS. 

4 ‘‘(a) IN GENERAL.—A group health plan and a health 

5 insurance issuer providing health insurance coverage in 

6 connection with a group health plan, may not impose an 

7 aggregate dollar lifetime limit of less than— 

8 ‘‘(1) with respect to the first 2 plan years after 

9 the effective date of this section, $5,000,000; 

10 ‘‘(2) with respect to the third and fourth plan 

11 years after such date, $10,000,000; and 

12 ‘‘(3) with respect to each subsequent year, the 

13 amount for the previous year adjusted by the per14 centage increase in the consumer price index (for all 

15 urban consumers) for such year; 

16 with respect to benefits payable under the plan or cov17 erage. 

18 ‘‘(b) SMALL EMPLOYERS.— 

19 ‘‘(1) IN GENERAL.—Subsection (a) shall not 

20 apply to any group health plan (and group health in21 surance coverage offered in connection with a group 

22 health plan) offered to or maintained for employees 

23 of a small employer, except that upon the request of 

24 such a small employer, the plan involved shall pro25 vide for the application of an aggregate dollar lifeVerDate Nov 24 2008 20:32 Feb 14, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1085.IH H1085

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1 time limit that is consistent with the limit required 

2 under such subsection. 

3 ‘‘(2) SMALL EMPLOYER.—For purposes of 

4 paragraph (1), the term ‘small employer’ means an 

5 employer who normally employed fewer than 20 em6 ployees on a typical business day during the pre7 ceding calendar year and who employs fewer than 20 

8 employees on the first day of the plan year. 

9 ‘‘(3) APPLICATION OF CERTAIN RULES IN DE10 TERMINATION OF EMPLOYER SIZE.—For purposes of 

11 this subsection— 

12 ‘‘(A) APPLICATION OF AGGREGATION RULE

13 FOR EMPLOYERS.—Rules similar to the rules 

14 under subsections (b), (c), (m), and (o) of sec15 tion 414 of the Internal Revenue Code of 1986 

16 shall apply for purposes of treating persons as 

17 a single employer. 

18 ‘‘(B) EMPLOYERS NOT IN EXISTENCE IN

19 PRECEDING YEAR.—In the case of an employer 

20 which was not in existence throughout the pre21 ceding calendar year, the determination of 

22 whether such employer is a small employer shall 

23 be based on the number of employees that it is 

24 reasonably expected such employer will normally 


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1 employ on a typical business day in the current 

2 calendar year. 

3 ‘‘(C) PREDECESSORS.—Any reference in 

4 this subsection to an employer shall include a 

5 reference to any predecessor of such employer. 

6 ‘‘(c) DEFINITION.—In this section, the term ‘aggre7 gate dollar lifetime limit’ means, with respect to benefits 

8 under a group health plan or health insurance coverage, 

9 a dollar limitation on the total amount that may be paid 

10 with respect to such benefits under the plan or health in11 surance coverage with respect to an individual or other 

12 coverage unit.’’. 

13 (b) CLERICAL AMENDMENT.—The table of contents 

14 in section 1 of such Act, is amended by inserting after 

15 the item relating to section 714 the following new item: 

‘‘Sec. 715. Limitation on lifetime aggregate limits.’’. 

16 (c) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply with respect to plan years begin18 ning on or after the date that is 1 year after the date 

19 of enactment of this Act. 

20 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT 

21 RELATING TO THE GROUP MARKET. 

22 (a) IN GENERAL.—Subpart 2 of part A of title 

23 XXVII of the Public Health Service Act (42 U.S.C. 

24 300gg–4 et seq.) is amended by adding at the end the 

25 following: 


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1 ‘‘SEC. 2708. LIMITATION ON LIFETIME AGGREGATE LIMITS. 

2 ‘‘(a) IN GENERAL.—A group health plan and a health 

3 insurance issuer providing health insurance coverage in 

4 connection with a group health plan, may not impose an 

5 aggregate dollar lifetime limit of less than— 

6 ‘‘(1) with respect to the first 2 plan years after 

7 the effective date of this section, $5,000,000; 

8 ‘‘(2) with respect to the third and fourth plan 

9 years after such date, $10,000,000; and 

10 ‘‘(3) with respect to each subsequent year, the 

11 amount for the previous year adjusted by the per12 centage increase in the consumer price index (for all 

13 urban consumers) for such year; 

14 with respect to benefits payable under the plan or cov15 erage. 

16 ‘‘(b) SMALL EMPLOYERS.— 

17 ‘‘(1) IN GENERAL.—Subsection (a) shall not 

18 apply to any group health plan (and group health in19 surance coverage offered in connection with a group 

20 health plan) offered to or maintained for employees 

21 of a small employer, except that upon the request of 

22 such a small employer, the plan involved shall pro23 vide for the application of an aggregate dollar life24 time limit that is consistent with the limit required 

25 under such subsection. 


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1 ‘‘(2) SMALL EMPLOYER.—For purposes of 

2 paragraph (1), the term ‘small employer’ means an 

3 employer who normally employed fewer than 20 em4 ployees on a typical business day during the pre5 ceding calendar year and who employs fewer than 20 

6 employees on the first day of the plan year. 

7 ‘‘(3) APPLICATION OF CERTAIN RULES IN DE8 TERMINATION OF EMPLOYER SIZE.—For purposes of 

9 this subsection— 

10 ‘‘(A) APPLICATION OF AGGREGATION RULE

11 FOR EMPLOYERS.—Rules similar to the rules 

12 under subsections (b), (c), (m), and (o) of sec13 tion 414 of the Internal Revenue Code of 1986 

14 shall apply for purposes of treating persons as 

15 a single employer. 

16 ‘‘(B) EMPLOYERS NOT IN EXISTENCE IN

17 PRECEDING YEAR.—In the case of an employer 

18 which was not in existence throughout the pre19 ceding calendar year, the determination of 

20 whether such employer is a small employer shall 

21 be based on the number of employees that it is 

22 reasonably expected such employer will normally 

23 employ on a typical business day in the current 

24 calendar year. 


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1 ‘‘(C) PREDECESSORS.—Any reference in 

2 this subsection to an employer shall include a 

3 reference to any predecessor of such employer. 

4 ‘‘(c) DEFINITION.—In this section, the term ‘aggre5 gate dollar lifetime limit’ means, with respect to benefits 

6 under a group health plan or health insurance coverage, 

7 a dollar limitation on the total amount that may be paid 

8 with respect to such benefits under the plan or health in9 surance coverage with respect to an individual or other 

10 coverage unit.’’. 

11 (b) EFFECTIVE DATE.—The amendment made by 

12 this section shall apply with respect to plan years begin13 ning on or after the date that is 1 year after the date 

14 of enactment of this Act. 

15 SEC. 4. STUDY BY THE INSTITUTE OF MEDICINE. 

16 The Secretary of Health and Human Services shall 

17 enter into a contract with the Institute of Medicine for 

18 the conduct of a study to determine the number of individ19 uals who have reached the lifetime limitations set forth 

20 in the amendments made by this Act beginning in the 

21 third plan year for which such amendments apply. Not 

22 later than 1 year after the date on which the study is con23 ducted under the previous sentence, the Institute of Medi24 cine shall submit to the Secretary and the appropriate 


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1 committees of Congress a report concerning the results of 

2 the study. 

Æ 


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