I 

116TH CONGRESS 

2D SESSION H. R. 8875 

To amend the Patient Protection and Affordable Care Act and the Employee 

Retirement Income Security Act of 1974 to establish a special enrollment 

period for eligible individuals who are enrolled in non-compliant health 

plans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 4, 2020 

Mr. KENNEDY 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 amend the Patient Protection and Affordable Care Act 

and the Employee Retirement Income Security Act of 

1974 to establish a special enrollment period for eligible 

individuals who are enrolled in non-compliant health 

plans, 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 ‘‘Health Insurance 

5 Lemon Law Act’’. 


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1 SEC. 2. ESTABLISHMENT OF A SPECIAL ENROLLMENT PE2 RIOD FOR ELIGIBLE INDIVIDUALS WHO ARE 

3 ENROLLED IN A NON-COMPLIANT HEALTH 

4 PLAN. 

5 (a) SPECIAL ENROLLMENT PERIODS FOR INDIVID6 UALS ENROLLED IN NON-COMPLIANT HEALTH PLANS.— 

7 (1) OPTION FOR ELIGIBLE INDIVIDUALS TO EN8 ROLL IN EXCHANGE PLANS THROUGH A SPECIAL EN9 ROLLMENT PERIOD.—Section 1311(c) of the Patient 

10 Protection and Affordable Care Act (42 U.S.C. 

11 18031(c)) is amended— 

12 (A) in paragraph (6)— 

13 (i) in subparagraph (C), by striking at 

14 the end ‘‘and’’; 

15 (ii) in subparagraph (D), by striking 

16 the period at the end and inserting ‘‘; 

17 and’’; and 

18 (iii) by adding at the end the fol19 lowing new subparagraph: 

20 ‘‘(E) special enrollment periods described 

21 in paragraph (8)(A).’’; and 

22 (B) by adding at the end the following new 

23 paragraph: 

24 ‘‘(8) SPECIAL ENROLLMENT PERIOD FOR INDI25 VIDUALS ENROLLED IN NON-COMPLIANT EXCHANGE


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1 PLANS TO ENROLL IN DIFFERENT EXCHANGE

2 PLANS.— 

3 ‘‘(A) IN GENERAL.—A special enrollment 

4 period described in this subparagraph is, begin5 ning 60 days after the date of the enactment of 

6 this paragraph, the 60-day period beginning on 

7 the date an eligible individual confirms receiv8 ing a notification that the health plan in which 

9 the eligible individual is enrolled is a non-com10 pliant health plan. 

11 ‘‘(B) SELF-ATTESTATION.—For purposes 

12 of qualifying for the special enrollment period 

13 described in subparagraph (A), the receipt of a 

14 notification that the health plan in which the el15 igible individual is enrolled is a non-compliant 

16 health plan shall be determined by the self-at17 testation of an eligible individual. 

18 ‘‘(C) DEFINITIONS.—In this paragraph: 

19 ‘‘(i) ELIGIBLE INDIVIDUAL.— 

20 ‘‘(I) IN GENERAL.—The term ‘el21 igible individual’ means a qualified in22 dividual who is enrolled in a non-com23 pliant health plan. 

24 ‘‘(II) INCLUSION.—Such term in25 cludes a covered employee (as defined 


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1 in section 607(2) of the Employee Re2 tirement Income Security Act of 

3 1974) who is enrolled in a non-compli4 ant health plan. 

5 ‘‘(ii) NON-COMPLIANT HEALTH

6 PLAN.—The term ‘non-compliant health 

7 plan’ means a group health plan or health 

8 insurance coverage offered by a health in9 surance issuer in the individual or small 

10 group market that is not so in compliance 

11 (as applicable) with any of— 

12 ‘‘(I) sections 2701, 2702, 2703, 

13 2704, 2705, 2706, 2708, 2709, 2711, 

14 2712, 2713, 2714, 2715, 2716, 2717, 

15 2718, 2719, 2719A, 2725, 2726, 

16 2727, 2728, or 2794 of the Public 

17 Health Service Act; 

18 ‘‘(II) sections 1302 or 1312 of 

19 the Patient Protection and Affordable 

20 Care Act; 

21 ‘‘(III) section 105 of the Internal 

22 Revenue Code of 1986; or 

23 ‘‘(IV) sections 601 through 608 

24 of the Employee Retirement Income 

25 Security Act of 1974.’’. 


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1 (2) OPTION FOR COVERED EMPLOYEES EN2 ROLLED IN NON-COMPLIANT GROUP HEALTH PLANS

3 TO ENROLL IN A DIFFERENT GROUP HEALTH

4 PLAN.—Section 701 of the Employee Retirement In5 come Security Act (29 U.S.C. 1181) is amended by 

6 inserting after paragraph (6) the following new 

7 paragraph: 

8 ‘‘(7) SPECIAL ENROLLMENT PERIOD FOR COV9 ERED EMPLOYEES ENROLLED IN NON-COMPLIANT

10 GROUP HEALTH PLANS TO ENROLL IN A DIFFERENT

11 GROUP HEALTH PLAN.— 

12 ‘‘(A) IN GENERAL.—Beginning 60 days 

13 after the date of the enactment of this para14 graph, a group health plan shall permit an em15 ployee who is enrolled in the group health plan 

16 that is not in compliance with a requirement 

17 specified under clause (C)(ii) of section 

18 1311(c)(8) of the Patient Protection and Af19 fordable Care Act (as applicable) to enroll in a 

20 different group health plan offered by the em21 ployer for a 60-day period beginning on the 

22 date the employee confirms receiving a notifica23 tion that the group health plan in which the 

24 employee is not so in compliance. 


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1 ‘‘(B) SELF-ATTESTATION.—For purposes 

2 of qualifying for the special enrollment period 

3 described in subparagraph (A), the receipt of a 

4 notification that the group health plan in which 

5 the eligible individual is enrolled is a non-com6 pliant health plan shall be determined by the 

7 self-attestation of an eligible individual.’’. 

8 (b) REQUIREMENT FOR FIRST DAY OF COVERAGE

9 FOR ELIGIBLE INDIVIDUALS ENROLLING DURING THE

10 SPECIAL ENROLLMENT PERIOD.— 

11 (1) NON-COMPLIANT EXCHANGE PLANS.—Sec12 tion 1303 of the Patient Protection and Affordable 

13 Care Act (42 U.S.C. 18023) is amended by adding 

14 at the end the following new subsection: 

15 ‘‘(e) REQUIREMENT FOR FIRST DAY OF COVERAGE

16 FOR ELIGIBLE INDIVIDUALS ENROLLING DURING THE

17 SPECIAL ENROLLMENT PERIOD.— 

18 ‘‘(1) NOTIFICATION REQUIREMENT.— 

19 ‘‘(A) IN GENERAL.—With respect to health 

20 insurance coverage in the individual or small 

21 group market group offered by a health insur22 ance issuer, any health insurance issuer of such 

23 coverage that is not in compliance with a re24 quirement specified under clause (C)(ii) of secVerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875

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1 tion 1311(c)(8) of the Patient Protection and 

2 Affordable Care Act shall— 

3 ‘‘(i) for the 30-day period beginning 

4 on the date the issuer receives a notice 

5 from the Secretary of Health and Human 

6 Services that such coverage is not so in 

7 compliance, attempt to receive confirma8 tion that each enrollee of such coverage is 

9 eligible for the special enrollment period 

10 described in section subparagraph (A) of 

11 such section; and 

12 ‘‘(ii) not later than 60 days after the 

13 date the issuer receives the notice de14 scribed in clause (i), in the case the cov15 erage does not receive confirmation for an 

16 enrollee pursuant to such clause, submit to 

17 the Secretary of Health and Human Serv18 ices the name of the enrollee and efforts to 

19 notify and receive confirmation from the 

20 enrollee. 

21 ‘‘(B) PRIVACY CONSIDERATIONS.—In car22 rying out this paragraph, the health insurance 

23 issuer shall take measures to ensure that infor24 mation as may be specifically permitted or re25 quired under other applicable provisions of law, 


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1 including HIPAA privacy and security law as 

2 defined in section 3009(a) of the Public Health 

3 Service Act (42 U.S.C. 300jj–19(a)) is not 

4 made public under this paragraph. 

5 ‘‘(2) REQUIREMENT FOR FIRST DAY OF COV6 ERAGE.—In the case of an eligible individual (as de7 fined in subparagraph (C) of section 1311(c)(8)) 

8 who enrolls in a qualified health plan through an 

9 Exchange during a month during the special enroll10 ment period described in subparagraph (A) of such 

11 section— 

12 ‘‘(A) coverage under health insurance cov13 erage offered a health insurance issuer in the 

14 individual or small group market shall termi15 nate on the last day of the such month in which 

16 the eligible individual so enrolls in the qualified 

17 health plan; and 

18 ‘‘(B) coverage under the qualified health 

19 plan shall be effective beginning on the first day 

20 of the first month succeeding the month termi21 nation of coverage described in subparagraph 

22 (A).’’. 

23 (2) NON-COMPLIANT GROUP HEALTH PLANS.— 

24 Section 701(7) of the Employee Retirement Income 

25 Security Act of 1974 (29 U.S.C. 1181(7)), as 


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1 amended by subsection (a)(2), is further amended, 

2 by inserting after subparagraph (B) the following 

3 new subparagraphs: 

4 ‘‘(C) NOTIFICATION REQUIREMENT.— 

5 ‘‘(i) IN GENERAL.—A group health 

6 plan that is not in compliance with a re7 quirement specified under subparagraph 

8 (C)(ii) of section 1311(c)(8) of the Patient 

9 Protection and Affordable Care Act shall— 

10 ‘‘(I) for the 30-day period begin11 ning after the date the plan receives a 

12 notice from the Secretary of Labor 

13 that such plan is not in compliance, 

14 attempt to receive confirmation that 

15 each enrollee of such plan was so noti16 fied of the special enrolled period de17 scribed in subparagraph (A) of such 

18 section and the special enrollment pe19 riod described in subparagraph (A); 

20 and 

21 ‘‘(II) not later than 60 days after 

22 the date the plan receives the notice 

23 described in clause (i), in the case the 

24 plan does not receive confirmation for 

25 an enrollee pursuant to such clause, 


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1 submit to the Secretary of Labor the 

2 name of the enrollee and efforts to no3 tify and receive confirmation from the 

4 enrollee. 

5 ‘‘(ii) PRIVACY CONSIDERATIONS.—In 

6 carrying out this subparagraph, the group 

7 health plan shall take measures to ensure 

8 that information as may be specifically 

9 permitted or required under other applica10 ble provisions of law, including HIPAA pri11 vacy and security law as defined in section 

12 3009(a) of the Public Health Service Act 

13 (42 U.S.C. 300jj–19(a)) is not made public 

14 under this subparagraph. 

15 ‘‘(D) REQUIREMENT FOR FIRST DAY OF

16 COVERAGE.—In the case of an eligible indi17 vidual (as defined in subparagraph (C) of sec18 tion 1311(c)(8) of the Patient Protection and 

19 Affordable Care Act) who is a covered employee 

20 and who— 

21 ‘‘(i) enrolls in a qualified health plan 

22 through an Exchange during a month dur23 ing the special enrollment period described 

24 in subparagraph (A) of such section— 


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1 ‘‘(I) coverage under a group 

2 health plan shall terminate on the last 

3 day of the such month in which the el4 igible individual so enrolls in the 

5 qualified health plan; and 

6 ‘‘(II) coverage under the qualified 

7 health plan shall be determined in ac8 cordance with section 1303(e)(2) of 

9 such Act; or 

10 ‘‘(ii) enrolls in a different group 

11 health plan offered by the employer of the 

12 covered employee pursuant to the special 

13 enrollment period described in subpara14 graph (A)— 

15 ‘‘(I) coverage under a group 

16 health plan shall terminate on the last 

17 day of the such month in which the el18 igible individual so enrolls in the 

19 qualified health plan; and 

20 ‘‘(II) coverage under the different 

21 group health plan offered by the em22 ployer of the qualified beneficiary 

23 shall be effective beginning on the 

24 first day of the first month succeeding 


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1 the month of termination of coverage 

2 described in subclause (I).’’. 

Æ 


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