I 

114TH CONGRESS 

1ST SESSION H. R. 2866 

To amend title XXVII of the Public Health Service Act to provide for 

a special enrollment period for pregnant women, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 23, 2015 

Mrs. WATSON COLEMAN (for herself, Ms. ADAMS, Ms. BASS, Mrs. BEATTY, 

Mr. BECERRA, Mr. BLUMENAUER, Ms. BROWN of Florida, Mr. 

BUTTERFIELD, Mrs. CAPPS, Mr. CA ́RDENAS, Mr. CARSON of Indiana, Ms. 

CASTOR of Florida, Ms. JUDY CHU of California, Ms. CLARK of Massachusetts, Mr. CLEAVER, Mr. CLYBURN, Mr. COHEN, Mr. CONNOLLY, Mr. 

CONYERS, Mr. CROWLEY, Mr. DANNY K. DAVIS of Illinois, Mr. 

DELANEY, Ms. DELAURO, Mr. DESAULNIER, Mrs. DINGELL, Ms. 

EDWARDS, Mr. ELLISON, Mr. FARR, Mr. FOSTER, Ms. FUDGE, Mr. 

GARAMENDI, Mr. GRIJALVA, Mr. GUTIE ́RREZ, Mr. HASTINGS, Mr. 

HONDA, Mr. ISRAEL, Ms. JACKSON LEE, Ms. EDDIE BERNICE JOHNSON

of Texas, Ms. KAPTUR, Ms. KELLY of Illinois, Mrs. KIRKPATRICK, Ms. 

KUSTER, Mr. LANGEVIN, Mrs. LAWRENCE, Ms. LEE, Mr. LEVIN, Mr. 

LEWIS, Mr. TED LIEU of California, Mrs. CAROLYN B. MALONEY of New 

York, Mr. SEAN PATRICK MALONEY of New York, Ms. MCCOLLUM, Mr. 

MCDERMOTT, Mr. MEEKS, Ms. MOORE, Mr. MOULTON, Mr. NADLER, 

Mrs. NAPOLITANO, Mr. NORCROSS, Ms. NORTON, Mr. O’ROURKE, Mr. 

PASCRELL, Mr. PAYNE, Mr. RICHMOND, Mr. RUSH, Ms. LINDA T. 

SA ́NCHEZ of California, Mr. DAVID SCOTT of Georgia, Mr. SIRES, Ms. 

SPEIER, Mr. THOMPSON of Mississippi, Mr. TONKO, Mrs. TORRES, Mr. 

VAN HOLLEN, Mr. VARGAS, Mr. VELA, Ms. MAXINE WATERS of California, Ms. WILSON of Florida, Mr. MCGOVERN, Ms. BONAMICI, Mr. 

BRENDAN F. BOYLE of Pennsylvania, Mr. PETERS, and Ms. CLARKE of 

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

Ways and Means and Oversight and Government Reform, 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 


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A BILL 

To amend title XXVII of the Public Health Service Act 

to provide for a special enrollment period for pregnant 

women, and for other purposes. 

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 ‘‘Healthy Maternity and 

5 Obstetric Medicine Act’’ or the ‘‘Healthy MOM Act’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) Pregnancy is a significant life event for mil9 lions of women in the United States each year. 

10 (2) For more than 30 years, our Nation, 

11 through the Medicaid program, has recognized that 

12 pregnant women need immediate access to afford13 able care, and has allowed women who meet income14 eligibility requirements to enroll in Medicaid cov15 erage when they become pregnant. 

16 (3) Congress recognized the central importance 

17 of maternity coverage by classifying maternity and 

18 newborn care as one of the ten essential health bene19 fits that must now be covered on most individual 

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1 tion 1302(b)(1) of the Patient Protection and Af2 fordable Care Act (42 U.S.C. 18022(b)(1)). 

3 (4) Access to comprehensive maternity coverage 

4 allows women to access important pregnancy-related 

5 care, which is demonstrated to improve health out6 comes for women and newborns and reduce financial 

7 costs for both consumers and insurers. 

8 (5) Uninsured women, women with grand9 fathered and transitional health plans, self-funded 

10 student health plans, and catastrophic and high-de11 ductible health plans may lack access to comprehen12 sive and affordable maternity coverage. 

13 (6) A special enrollment period is especially im14 portant for young adults, who are at high risk for 

15 unintended pregnancies, yet young adults are fre16 quently enrolled in catastrophic coverage, which 

17 often has fewer benefits, more restrictions, and high18 er deductibles. 

19 (7) Timely maternity care improves the health 

20 of pregnant women, as well as birth outcomes and 

21 the health of babies throughout their lifetimes. Preg22 nancy-related maternal mortality is three to four 

23 times higher among women who receive no maternity 

24 care compared to women who do. Regular maternity 

25 care can detect or mitigate serious pregnancy-related 


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1 health complications, including preeclampsia, pla2 cental abruption, complications from diabetes, com3 plications from heart disease, and Graves’ disease, 

4 all of which can result in morbidity or mortality for 

5 the mother or newborn. 

6 (8) Regular maternity care can reduce preterm 

7 births and the health complications associated with 

8 preterm births. 

9 (9) Timely maternity care can reduce short10 and long-term health care costs. If a woman does 

11 not have access to affordable maternity care during 

12 her pregnancy, and she or her newborn experiences 

13 pregnancy complications that result in health prob14 lems after birth, their insurer may end up paying 

15 much higher costs than if the insurer had covered 

16 the woman’s maternity care during her pregnancy. 

17 Intensive maternity care can reduce hospital and 

18 neonatal intensive care unit admissions among in19 fants, resulting in cost savings of $1,768 to $5,560 

20 per birth. For women with high-risk pregnancies, in21 tensive maternity care saves $1.37 for every $1 in22 vested in maternity care. 

23 (b) PURPOSE.—The purpose of this Act is to protect 

24 the health of women and newborns by ensuring that all 

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1 lished under title I of the Patient Protection and Afford2 able Care Act (Public Law 111–148) can access affordable 

3 health coverage during their pregnancy. 

4 SEC. 3. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD 

5 FOR PREGNANT WOMEN. 

6 (a) PUBLIC HEALTH SERVICE ACT.—Section 

7 2702(b)(2) of the Public Health Service Act (42 U.S.C. 

8 300gg–1(b)(2)) is amended by inserting ‘‘including a spe9 cial enrollment period for pregnant women, beginning on 

10 the date on which the pregnancy is reported to the health 

11 insurance issuer’’ before the period at the end. 

12 (b) PATIENT PROTECTION AND AFFORDABLE CARE

13 ACT.—Section 1311(c)(6) of the Patient Protection and 

14 Affordable Care Act (42 U.S.C. 18031(c)(6)) is amend15 ed— 

16 (1) in subparagraph (C), by striking ‘‘and’’ at 

17 the end; 

18 (2) by redesignating subparagraph (D) as sub19 paragraph (E); and 

20 (3) by inserting after subparagraph (C) the fol21 lowing new subparagraph: 

22 ‘‘(D) a special enrollment period for preg23 nant women, beginning on the date on which 

24 the pregnancy is reported to the Exchange; 

25 and’’. 


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1 (c) SPECIAL ENROLLMENT PERIODS.—Section 

2 9801(f) of the Internal Revenue Code of 1986 (26 U.S.C. 

3 9801(f)) is amended by adding at the end the following 

4 new paragraph: 

5 ‘‘(4) FOR PREGNANT WOMEN.— 

6 ‘‘(A) A group health plan shall permit an 

7 employee who is eligible, but not enrolled, for 

8 coverage under the terms of the plan (or a de9 pendent of such an employee if the dependent 

10 is eligible, but not enrolled, for coverage under 

11 such terms) to enroll for coverage under the 

12 terms of the plan upon pregnancy, with the spe13 cial enrollment period beginning on the date on 

14 which the pregnancy is reported to the group 

15 health plan. 

16 ‘‘(B) The Secretary shall promulgate regu17 lations with respect to the special enrollment 

18 period under subparagraph (A), including es19 tablishing a time period for pregnant women to 

20 enroll in coverage and effective date of such 

21 coverage.’’. 

22 (d) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply with respect to plan years begin24 ning after the 2016 plan year. 


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1 SEC. 4. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS. 

2 (a) IN GENERAL.—The Director of the Office of Per3 sonnel Management shall issue such regulations as are 

4 necessary to ensure that pregnancy is considered a change 

5 in family status and a qualifying life event for an indi6 vidual who is eligible to enroll, but is not enrolled, in a 

7 health benefit plan under chapter 89 title 5, United States 

8 Code. 

9 (b) EFFECTIVE DATE.—The requirement in sub10 section (a) shall apply with respect to any contract entered 

11 into under section 8902 of such title beginning 12 months 

12 after the date of enactment of this Act. 

Æ 


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