I

106TH CONGRESS

1ST SESSION H. R. 2041

To amend title I of the Employee Retirement Income Security Act of 1974

to provide to participants and beneficiaries of group health plans access

to obstetric and gynecological care.

IN THE HOUSE OF REPRESENTATIVES

JUNE 8, 1999

Ms. GRANGER (for herself, Mrs. KELLY, Mrs. WILSON, and Ms. PRYCE of

Ohio) introduced the following bill; which was referred to the Committee

on Education and the Workforce

A BILL

To amend title I of the Employee Retirement Income Security Act of 1974 to provide to participants and beneficiaries of group health plans access to obstetric and

gynecological care.

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 ‘‘Patient Right to Ob5 stetric and Gynecological Care Act of 1999’’.
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1 SEC. 2. PATIENT ACCESS TO OBSTETRIC AND GYNECO2 LOGICAL CARE.

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

4 B of title I of the Employee Retirement Income Security

5 Act of 1974 is amended by adding at the end the following

6 new section:

7 ‘‘SEC. 714. PATIENT ACCESS TO OBSTETRIC AND GYNECO8 LOGICAL CARE

9 ‘‘(a) IN GENERAL.—In any case in which a group

10 health plan (or a health insurance issuer offering health

11 insurance coverage in connection with the plan)—

12 ‘‘(1) provides benefits under the terms of the

13 plan consisting of—

14 ‘‘(A) routine gynecological care (such as

15 preventive women’s health examinations); or

16 ‘‘(B) routine obstetric care (such as rou17 tine pregnancy-related services),

18 provided by a participating physician who specializes

19 in such care (or provides benefits consisting of pay20 ment for such care); and

21 ‘‘(2) requires or provides for designation by a

22 participant or beneficiary of a participating primary

23 care provider,

24 if the primary care provider designated by such a partici25 pant or beneficiary is not such a physician, then the plan

26 (or issuer) shall meet the requirements of subsection (b).
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1 ‘‘(b) REQUIREMENTS.—A group health plan (or a

2 health insurance issuer offering health insurance coverage

3 in connection with the plan) meets the requirements of

4 this subsection, in connection with benefits described in

5 subsection (a) consisting of care described in subpara6 graph (A) or (B) of subsection (a)(1) (or consisting of

7 payment therefor), if the plan (or issuer)—

8 ‘‘(1) does not require authorization or a referral

9 by the primary care provider in order to obtain such

10 benefits; and

11 ‘‘(2) treats the ordering of other routine care of

12 the same type, by the participating physician pro13 viding the care described in subparagraph (A) or (B)

14 of subsection (a)(1), as the authorization of the pri15 mary care provider with respect to such care.

16 ‘‘(c) CONSTRUCTION.—Nothing in subsection (b)(2)

17 shall waive any requirements of coverage relating to med18 ical necessity or appropriateness with respect to coverage

19 of gynecological or obstetric care so ordered.

20 ‘‘(d) TREATMENT OF MULTIPLE COVERAGE OP21 TIONS.—In the case of a plan providing benefits under two

22 or more coverage options, the requirements of this section

23 shall apply separately with respect to each coverage op24 tion.’’.
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1 (b) CONFORMING AMENDMENT.—The table of con2 tents in section 1 of such Act is amended by adding at

3 the end of the items relating to subpart B of part 7 of

4 subtitle B of title I of such Act the following new item:

‘‘Sec. 714. Patient access to obstetric and gynecological care.’’.

5 SEC. 3. EFFECTIVE DATE AND RELATED RULES.

6 (a) IN GENERAL.—The amendments made by this

7 Act shall apply with respect to plan years beginning on

8 or after January 1 of the second calendar year following

9 the date of the enactment of this Act, except that the Sec10 retary of Labor may issue regulations before such date

11 under such amendments. The Secretary shall first issue

12 regulations necessary to carry out the amendments made

13 by this Act before the effective date thereof.

14 (b) LIMITATION ON ENFORCEMENT ACTIONS.—No

15 enforcement action shall be taken, pursuant to the amend16 ments made by this Act, against a group health plan or

17 health insurance issuer with respect to a violation of a re18 quirement imposed by such amendments before the date

19 of issuance of regulations issued in connection with such

20 requirement, if the plan or issuer has sought to comply

21 in good faith with such requirement.

22 (c) SPECIAL RULE FOR COLLECTIVE BARGAINING

23 AGREEMENTS.—In the case of a group health plan main24 tained pursuant to one or more collective bargaining

25 agreements between employee representatives and one or
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1 more employers ratified before the date of the enactment

2 of this Act, the amendments made by this Act shall not

3 apply with respect to plan years beginning before the later

4 of—

5 (1) the date on which the last of the collective

6 bargaining agreements relating to the plan termi7 nates (determined without regard to any extension

8 thereof agreed to after the date of the enactment of

9 this Act); or

10 (2) January 1, 2002.

11 For purposes of this subsection, any plan amendment

12 made pursuant to a collective bargaining agreement relat13 ing to the plan which amends the plan solely to conform

14 to any requirement added by this Act shall not be treated

15 as a termination of such collective bargaining agreement.

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