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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 543 Introduced in Senate (IS)]

106th CONGRESS
  1st Session
                                 S. 543

  To prohibit discrimination on the basis of genetic information with 
                      respect to health insurance.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             March 4, 1999

    Ms. Snowe  (for herself, Mr. Frist, Mr. Jeffords Mr. Hagel, Ms. 
 Collins, and Mr. Enzi) introduced the following bill; which was read 
  twice and referred to the Committee on Health Education, Labor, and 
                                Pensions

_______________________________________________________________________

                                 A BILL

 
  To prohibit discrimination on the basis of genetic information with 
                      respect to health insurance.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Genetic Information 
Nondiscrimination in Health Insurance Act of 1999''.

SEC. 2. AMENDMENTS TO EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.

    (a) Prohibition of Health Discrimination on the Basis of Genetic 
Information or Genetic Services.--
            (1) No enrollment restriction for genetic services.--
        Section 702(a)(1)(F) of the Employee Retirement Income Security 
        Act of 1974 (29 U.S.C. 1182(a)(1)(F)) is amended by inserting 
        before the period the following: ``(including information about 
        a request for or receipt of genetic services)''.
            (2) No discrimination in group premiums based on predictive 
        genetic information.--Subpart B of part 7 of subtitle B of 
        title I of the Employee Retirement Income Security Act of 1974, 
        as amended by the Omnibus Consolidated and Emergency 
        Supplemental Appropriations Act, 1999 (Public Law 105-277), is 
        amended by adding at the end the following:

``SEC. 714. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE 
              BASIS OF PREDICTIVE GENETIC INFORMATION.

    ``A group health plan, or a health insurance issuer offering group 
health insurance coverage in connection with a group health plan, shall 
not adjust premium or contribution amounts for a group on the basis of 
predictive genetic information concerning an individual in the group or 
a family member of the individual (including information about a 
request for or receipt of genetic services).''.
            (3) Conforming amendments.--
                    (A) In general.--Section 702(b) of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1182(b)) is amended by adding at the end the following:
            ``(3) Reference to related provision.--For a provision 
        prohibiting the adjustment of premium or contribution amounts 
        for a group under a group health plan on the basis of 
        predictive genetic information (including information about a 
        request for or receipt of genetic services), see section 
        714.''.
                    (B) Table of contents.--The table of contents in 
                section 1 of the Employee Retirement Income Security 
                Act of 1974 is amended by inserting after the item 
                relating to section 713 the following new item:

``Sec. 714. Prohibiting premium discrimination against groups on the 
                            basis of predictive genetic information.''.
    (b) Limitation on Collection of Predictive Genetic Information.--
Section 702 of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1182) is amended by adding at the end the following:
    ``(c) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        group health plan, or a health insurance issuer offering health 
        insurance coverage in connection with a group health plan, 
        shall not request or require predictive genetic information 
        concerning an individual or a family member of the individual 
        (including information about a request for or receipt of 
        genetic services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                group health plan, or a health insurance issuer 
                offering health insurance coverage in connection with a 
                group health plan, that provides health care items and 
                services to an individual or dependent may request (but 
                may not require) that such individual or dependent 
                disclose, or authorize the collection or disclosure of, 
                predictive genetic information for purposes of 
                diagnosis, treatment, or payment relating to the 
                provision of health care items and services to such 
                individual or dependent.
                    ``(B) Notice of confidentiality practices and 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the group health plan, or a 
                health insurance issuer offering health insurance 
                coverage in connection with a group health plan, shall 
                provide to the individual or dependent a description of 
                the procedures in place to safeguard the 
                confidentiality, as described in subsection (d), of 
                such predictive genetic information.
    ``(d) Confidentiality With Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A group 
                health plan, or a health insurance issuer offering 
                health insurance coverage in connection with a group 
                health plan, shall post or provide, in writing and in a 
                clear and conspicuous manner, notice of the plan or 
                issuer's confidentiality practices, that shall 
                include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        plan or issuer for the exercise of the 
                        individual's rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A group health plan, or 
        a health insurance issuer offering health insurance coverage in 
        connection with a group health plan, shall establish and 
        maintain appropriate administrative, technical, and physical 
        safeguards to protect the confidentiality, security, accuracy, 
        and integrity of predictive genetic information created, 
        received, obtained, maintained, used, transmitted, or disposed 
        of by such plan or issuer.''.
    (c) Definitions.--Section 733(d) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1191b(d)) is amended by adding at the 
end the following:
            ``(5) Family member.--The term `family member' means with 
        respect to an individual--
                    ``(A) the spouse of the individual;
                    ``(B) a dependent child of the individual, 
                including a child who is born to or placed for adoption 
                with the individual; and
                    ``(C) all other individuals related by blood to the 
                individual or the spouse or child described in 
                subparagraph (A) or (B).
            ``(6) Genetic information.--The term `genetic information' 
        means information about genes, gene products, or inherited 
        characteristics that may derive from an individual or a family 
        member (including information about a request for or receipt of 
        genetic services).
            ``(7) Genetic services.--The term `genetic services' means 
        health services provided to obtain, assess, or interpret 
        genetic information for diagnostic and therapeutic purposes, 
        and for genetic education and counseling.
            ``(8) Predictive genetic information.--
                    ``(A) In general.--The term `predictive genetic 
                information' means, in the absence of symptoms, 
                clinical signs, or a diagnosis of the condition related 
                to such information--
                            ``(i) information about an individual's 
                        genetic tests;
                            ``(ii) information about genetic tests of 
                        family members of the individual; or
                            ``(iii) information about the occurrence of 
                        a disease or disorder in family members.
                    ``(B) Exceptions.--The term `predictive genetic 
                information' shall not include--
                            ``(i) information about the sex or age of 
                        the individual;
                            ``(ii) information derived from physical 
                        tests, such as the chemical, blood, or urine 
                        analyses of the individual including 
                        cholesterol tests; and
                            ``(iii) information about physical exams of 
                        the individual.
            ``(9) Genetic test.--The term `genetic test' means the 
        analysis of human DNA, RNA, chromosomes, proteins, and certain 
        metabolites, including analysis of genotypes, mutations, 
        phenotypes, or karyotypes, for the purpose of predicting risk 
        of disease in asymptomatic or undiagnosed individuals.''.
    (d) Effective Date.--Except as provided in this section, this 
section and the amendments made by this section shall apply with 
respect to group health plans for plan years beginning 1 year after the 
date of the enactment of this Act.

SEC. 3. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Amendments Relating to the Group Market.--
            (1) Prohibition of health discrimination on the basis of 
        genetic information in the group market.--
                    (A) No enrollment restriction for genetic 
                services.--Section 2702(a)(1)(F) of the Public Health 
                Service Act (42 U.S.C. 300gg-1(a)(1)(F)) is amended by 
                inserting before the period the following: ``(including 
                information about a request for or receipt of genetic 
                services)''.
                    (B) No discrimination in premiums based on 
                predictive genetic information.--Subpart 2 of part A of 
                title XXVII of the Public Health Service Act, as 
                amended by the Omnibus Consolidated and Emergency 
                Supplemental Appropriations Act, 1999 (Public Law 105-
                277), is amended by adding at the end the following new 
                section:

``SEC. 2707. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE 
              BASIS OF PREDICTIVE GENETIC INFORMATION IN THE GROUP 
              MARKET.

    ``A group health plan, or a health insurance issuer offering group 
health insurance coverage in connection with a group health plan shall 
not adjust premium or contribution amounts for a group on the basis of 
predictive genetic information concerning an individual in the group or 
a family member of the individual (including information about a 
request for or receipt of genetic services).''.
                    (C) Conforming amendment.--Section 2702(b) of the 
                Public Health Service Act (42 U.S.C. 300gg-1(b)) is 
                amended by adding at the end the following:
            ``(3) Reference to related provision.--For a provision 
        prohibiting the adjustment of premium or contribution amounts 
        for a group under a group health plan on the basis of 
        predictive genetic information (including information about a 
        request for or receipt of genetic services), see section 
        2707.''.
                    (D) Limitation on collection and disclosure of 
                predictive genetic information.--Section 2702 of the 
                Public Health Service Act (42 U.S.C. 300gg-1) is 
                amended by adding at the end the following:
    ``(c) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        group health plan, or a health insurance issuer offering health 
        insurance coverage in connection with a group health plan, 
        shall not request or require predictive genetic information 
        concerning an individual or a family member of the individual 
        (including information about a request for or receipt of 
        genetic services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                group health plan, or a health insurance issuer 
                offering health insurance coverage in connection with a 
                group health plan, that provides health care items and 
                services to an individual or dependent may request (but 
                may not require) that such individual or dependent 
                disclose, or authorize the collection or disclosure of, 
                predictive genetic information for purposes of 
                diagnosis, treatment, or payment relating to the 
                provision of health care items and services to such 
                individual or dependent.
                    ``(B) Notice of confidentiality practices and 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the group health plan, or a 
                health insurance issuer offering health insurance 
                coverage in connection with a group health plan, shall 
                provide to the individual or dependent a description of 
                the procedures in place to safeguard the 
                confidentiality, as described in subsection (d), of 
                such predictive genetic information.
    ``(d) Confidentiality With Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A group 
                health plan, or a health insurance issuer offering 
                health insurance coverage in connection with a group 
                health plan, shall post or provide, in writing and in a 
                clear and conspicuous manner, notice of the plan or 
                issuer's confidentiality practices, that shall 
                include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        plan or issuer for the exercise of the 
                        individual's rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A group health plan, or 
        a health insurance issuer offering health insurance coverage in 
        connection with a group health plan, shall establish and 
        maintain appropriate administrative, technical, and physical 
        safeguards to protect the confidentiality, security, accuracy, 
        and integrity of predictive genetic information created, 
        received, obtained, maintained, used, transmitted, or disposed 
        of by such plan or issuer.''.
            (2) Definitions.--Section 2791(d) of the Public Health 
        Service Act (42 U.S.C. 300gg-91(d)) is amended by adding at the 
        end the following:
            ``(15) Family member.--The term `family member' means, with 
        respect to an individual--
                    ``(A) the spouse of the individual;
                    ``(B) a dependent child of the individual, 
                including a child who is born to or placed for adoption 
                with the individual; and
                    ``(C) all other individuals related by blood to the 
                individual or the spouse or child described in 
                subparagraph (A) or (B).
            ``(16) Genetic information.--The term `genetic information' 
        means information about genes, gene products, or inherited 
        characteristics that may derive from an individual or a family 
        member (including information about a request for or receipt of 
        genetic services).
            ``(17) Genetic services.--The term `genetic services' means 
        health services provided to obtain, assess, or interpret 
        genetic information for diagnostic and therapeutic purposes, 
        and for genetic education and counseling.
            ``(18) Predictive genetic information.--
                    ``(A) In general.--The term `predictive genetic 
                information' means, in the absence of symptoms, 
                clinical signs, or a diagnosis of the condition related 
                to such information--
                            ``(i) information about an individual's 
                        genetic tests;
                            ``(ii) information about genetic tests of 
                        family members of the individual; or
                            ``(iii) information about the occurrence of 
                        a disease or disorder in family members.
                    ``(B) Exceptions.--The term `predictive genetic 
                information' shall not include--
                            ``(i) information about the sex or age of 
                        the individual;
                            ``(ii) information derived from physical 
                        tests, such as the chemical, blood, or urine 
                        analyses of the individual including 
                        cholesterol tests; and
                            ``(iii) information about physical exams of 
                        the individual.
            ``(19) Genetic test.--The term `genetic test' means the 
        analysis of human DNA, RNA, chromosomes, proteins, and certain 
        metabolites, including analysis of genotypes, mutations, 
        phenotypes, or karyotypes, for the purpose of predicting risk 
        of disease in asymptomatic or undiagnosed individuals.''.
    (b) Amendment Relating to the Individual Market.--The first subpart 
3 of part B of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-51 et seq.) (relating to other requirements), as amended by the 
Omnibus Consolidated and Emergency Supplemental Appropriations Act, 
1999 (Public Law 105-277) is amended--
            (1) by redesignating such subpart as subpart 2; and
            (2) by adding at the end the following:

``SEC. 2753. PROHIBITION OF HEALTH DISCRIMINATION ON THE BASIS OF 
              PREDICTIVE GENETIC INFORMATION.

    ``(a) Prohibition on Predictive Genetic Information as a Condition 
of Eligibility.--A health insurance issuer offering health insurance 
coverage in the individual market may not use predictive genetic 
information as a condition of eligibility of an individual to enroll in 
individual health insurance coverage (including information about a 
request for or receipt of genetic services).
    ``(b) Prohibition on Predictive Genetic Information in Setting 
Premium Rates.--A health insurance issuer offering health insurance 
coverage in the individual market shall not adjust premium rates for 
individuals on the basis of predictive genetic information concerning 
such an enrollee or a family member of the enrollee (including 
information about a request for or receipt of genetic services).
    ``(c) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        health insurance issuer offering health insurance coverage in 
        the individual market shall not request or require predictive 
        genetic information concerning an individual or a family member 
        of the individual (including information about a request for or 
        receipt of genetic services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                health insurance issuer offering health insurance 
                coverage in the individual market that provides health 
                care items and services to an individual or dependent 
                may request (but may not require) that such individual 
                or dependent disclose, or authorize the collection or 
                disclosure of, predictive genetic information for 
                purposes of diagnosis, treatment, or payment relating 
                to the provision of health care items and services to 
                such individual or dependent.
                    ``(B) Notice of confidentiality practices and 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the health insurance issuer 
                offering health insurance coverage in the individual 
                market shall provide to the individual or dependent a 
                description of the procedures in place to safeguard the 
                confidentiality, as described in subsection (d), of 
                such predictive genetic information.
    ``(d) Confidentiality With Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A health 
                insurance issuer offering health insurance coverage in 
                the individual market shall post or provide, in writing 
                and in a clear and conspicuous manner, notice of the 
                issuer's confidentiality practices, that shall 
                include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        issuer for the exercise of the individual's 
                        rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A health insurance 
        issuer offering health insurance coverage in the individual 
        market shall establish and maintain appropriate administrative, 
        technical, and physical safeguards to protect the 
        confidentiality, security, accuracy, and integrity of 
        predictive genetic information created, received, obtained, 
        maintained, used, transmitted, or disposed of by such 
        issuer.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to--
            (1) group health plans, and health insurance coverage 
        offered in connection with group health plans, for plan years 
        beginning after 1 year after the date of enactment of this Act; 
        and
            (2) health insurance coverage offered, sold, issued, 
        renewed, in effect, or operated in the individual market after 
        1 year after the date of enactment of this Act.

SEC. 4. AMENDMENTS TO THE INTERNAL REVENUE CODE OF 1986.

    (a) Prohibition of Health Discrimination on the Basis of Genetic 
Information or Genetic Services.--
            (1) No enrollment restriction for genetic services.--
        Section 9802(a)(1)(F) of the Internal Revenue Code of 1986 is 
        amended by inserting before the period the following: 
        ``(including information about a request for or receipt of 
        genetic services)''.
            (2) No discrimination in group premiums based on predictive 
        genetic information.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following:

``SEC. 9813. PROHIBITING PREMIUM DISCRIMINATION AGAINST GROUPS ON THE 
              BASIS OF PREDICTIVE GENETIC INFORMATION.

    ``A group health plan shall not adjust premium or contribution 
amounts for a group on the basis of predictive genetic information 
concerning an individual in the group or a family member of the 
individual (including information about a request for or receipt of 
genetic services).''.
                    (B) Conforming amendment.--Section 9802(b) of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following:
            ``(3) Reference to related provision.--For a provision 
        prohibiting the adjustment of premium or contribution amounts 
        for a group under a group health plan on the basis of 
        predictive genetic information (including information about a 
        request for or the receipt of genetic services), see section 
        9813.''.
                    (C) Amendment to table of sections.--The table of 
                sections for subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following:

``Sec. 9813. Prohibiting premium discrimination against groups on the 
                            basis of predictive genetic information.''.
    (b) Limitation on Collection of Predictive Genetic Information.--
Section 9802 of the Internal Revenue Code of 1986 is amended by adding 
at the end the following:
    ``(d) Collection of Predictive Genetic Information.--
            ``(1) Limitation on requesting or requiring predictive 
        genetic information.--Except as provided in paragraph (2), a 
        group health plan shall not request or require predictive 
        genetic information concerning an individual or a family member 
        of the individual (including information about a request for or 
        receipt of genetic services).
            ``(2) Information needed for diagnosis, treatment, or 
        payment.--
                    ``(A) In general.--Notwithstanding paragraph (1), a 
                group health plan that provides health care items and 
                services to an individual or dependent may request (but 
                may not require) that such individual or dependent 
                disclose, or authorize the collection or disclosure of, 
                predictive genetic information for purposes of 
                diagnosis, treatment, or payment relating to the 
                provision of health care items and services to such 
                individual or dependent.
                    ``(B) Notice of confidentiality practices; 
                description of safeguards.--As a part of a request 
                under subparagraph (A), the group health plan shall 
                provide to the individual or dependent a description of 
                the procedures in place to safeguard the 
                confidentiality, as described in subsection (e), of 
                such predictive genetic information.
    ``(e) Confidentiality With Respect to Predictive Genetic 
Information.--
            ``(1) Notice of confidentiality practices.--
                    ``(A) Preparation of written notice.--A group 
                health plan shall post or provide, in writing and in a 
                clear and conspicuous manner, notice of the plan's 
                confidentiality practices, that shall include--
                            ``(i) a description of an individual's 
                        rights with respect to predictive genetic 
                        information;
                            ``(ii) the procedures established by the 
                        plan for the exercise of the individual's 
                        rights; and
                            ``(iii) the right to obtain a copy of the 
                        notice of the confidentiality practices 
                        required under this subsection.
                    ``(B) Model notice.--The Secretary, in consultation 
                with the National Committee on Vital and Health 
                Statistics and the National Association of Insurance 
                Commissioners, and after notice and opportunity for 
                public comment, shall develop and disseminate model 
                notices of confidentiality practices. Use of the model 
                notice shall serve as a defense against claims of 
                receiving inappropriate notice.
            ``(2) Establishment of safeguards.--A group health plan 
        shall establish and maintain appropriate administrative, 
        technical, and physical safeguards to protect the 
        confidentiality, security, accuracy, and integrity of 
        predictive genetic information created, received, obtained, 
        maintained, used, transmitted, or disposed of by such plan.''.
    (c) Definitions.--Section 9832(d) of the Internal Revenue Code of 
1986 is amended by adding at the end the following:
            ``(6) Family member.--The term `family member' means, with 
        respect to an individual--
                    ``(A) the spouse of the individual;
                    ``(B) a dependent child of the individual, 
                including a child who is born to or placed for adoption 
                with the individual; and
                    ``(C) all other individuals related by blood to the 
                individual or the spouse or child described in 
                subparagraph (A) or (B).
            ``(7) Genetic information.--The term `genetic information' 
        means information about genes, gene products, or inherited 
        characteristics that may derive from an individual or a family 
        member (including information about a request for or receipt of 
        genetic services).
            ``(8) Genetic services.--The term `genetic services' means 
        health services provided to obtain, assess, or interpret 
        genetic information for diagnostic and therapeutic purposes, 
        and for genetic education and counseling.
            ``(9) Predictive genetic information.--
                    ``(A) In general.--The term `predictive genetic 
                information' means, in the absence of symptoms, 
                clinical signs, or a diagnosis of the condition related 
                to such information--
                            ``(i) information about an individual's 
                        genetic tests;
                            ``(ii) information about genetic tests of 
                        family members of the individual; or
                            ``(iii) information about the occurrence of 
                        a disease or disorder in family members.
                    ``(B) Exceptions.--The term `predictive genetic 
                information' shall not include--
                            ``(i) information about the sex or age of 
                        the individual;
                            ``(ii) information derived from physical 
                        tests, such as the chemical, blood, or urine 
                        analyses of the individual including 
                        cholesterol tests; and
                            ``(iii) information about physical exams of 
                        the individual.
            ``(10) Genetic test.--The term `genetic test' means the 
        analysis of human DNA, RNA, chromosomes, proteins, and certain 
        metabolites, including analysis of genotypes, mutations, 
        phenotypes, or karyotypes, for the purpose of predicting risk 
        of disease in asymptomatic or undiagnosed individuals.''.
    (d) Effective Date.--Except as provided in this section, this 
section and the amendments made by this section shall apply with 
respect to group health plans for plan years beginning after 1 year 
after the date of the enactment of this Act.
                                 <all>
```