I 

110TH CONGRESS 

2D SESSION H. R. 5449 

To amend the Employee Retirement Income Security Act of 1974, Public 

Health Service Act, and the Internal Revenue Code of 1986 to prohibit 

discrimination in group health coverage and individual health insurance 

coverage. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 14, 2008 

Mr. KAGEN (for himself, Mr. BRALEY of Iowa, Mr. PERLMUTTER, Mr. 

COHEN, Mr. MCNERNEY, Ms. CASTOR, Mr. WALZ of Minnesota, Mr. 

JOHNSON of Georgia, Mr. GRIJALVA, Ms. HIRONO, Mrs. NAPOLITANO, 

Ms. SUTTON, Ms. CLARKE, Mr. CONYERS, and Mr. ELLISON) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committees on Education and Labor 

and Ways and Means, 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 Employee Retirement Income Security Act 

of 1974, Public Health Service Act, and the Internal 

Revenue Code of 1986 to prohibit discrimination in 

group health coverage and individual health insurance 

coverage. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; PURPOSE. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘No Discrimination in Health Insurance Act of 2008’’. 

4 (b) PURPOSE.—It is the purpose of this Act to— 

5 (1) eliminate the application of pre-existing con6 dition exclusions in all group health coverage policies 

7 and all individual health insurance policies; and 

8 (2) provide that all health insurance issuers de9 termine and openly disclose the premium price for 

10 each and every group health insurance policy and 

11 each and every individual health insurance policy, 

12 such that within a specific metropolitan statistical 

13 area, or other geographic area, all such premiums 

14 and prices established by a given issuer shall be uni15 form. 

16 SEC. 2. NONDISCRIMINATION IN GROUP HEALTH COV17 ERAGE. 

18 (a) APPLICATION UNDER THE EMPLOYEE RETIRE19 MENT INCOME SECURITY ACT OF 1974.— 

20 (1) ELIMINATION OF PREEXISTING CONDITION

21 EXCLUSIONS.—Section 701 of the Employee Retire22 ment Income Security Act of 1974 (29 U.S.C. 1181) 

23 is amended— 

24 (A) by amending the heading to read as 

25 follows: ‘‘ELIMINATION OF PREEXISTING

26 CONDITION EXCLUSIONS’’; 


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1 (B) by amending subsection (a) to read as 

2 follows: 

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

4 health insurance issuer offering group health insurance 

5 coverage, with respect to a participant or beneficiary— 

6 ‘‘(1) may not impose any pre-existing condition 

7 exclusion; and 

8 ‘‘(2) in the case of a group health plan that of9 fers medical care through health insurance coverage 

10 offered by a health maintenance organization, may 

11 not provide for an affiliation period with respect to 

12 coverage through the organization.’’; 

13 (C) in subsection (b), by striking para14 graph (3) and inserting the following: 

15 ‘‘(3) AFFILIATION PERIOD.—The term ‘affili16 ation period’ means a period which, under the terms 

17 of the health insurance coverage offered by the 

18 health maintenance organization, must expire before 

19 the health insurance coverage becomes effective.’’; 

20 (D) by striking subsections (c), (d), (e), 

21 and (g); and 

22 (E) by redesignating subsection (f) (relat23 ing to special enrollment periods) as subsection 

24 (c). 


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1 (2) CLERICAL AMENDMENT.—The item in the 

2 table of contents of such Act relating to section 701 

3 is amended to read as follows: 

‘‘Sec. 701. Elimination of pre-existing condition exclusions.’’. 

4 (b) APPLICATION UNDER THE INTERNAL REVENUE

5 CODE OF 1986.— 

6 (1) ELIMINATION OF PREEXISTING CONDITION

7 EXCLUSIONS.—Section 9801 of the Internal Revenue 

8 Code of 1986 is amended— 

9 (A) by amending the heading to read as 

10 follows: ‘‘ELIMINATION OF PREEXISTING

11 CONDITION EXCLUSIONS’’; 

12 (B) by amending subsection (a) to read as 

13 follows: 

14 ‘‘(a) IN GENERAL.—A group health plan with respect 

15 to a participant or beneficiary may not impose any pre16 existing condition exclusion.’’; 

17 (C) by striking paragraph (3) of subsection 

18 (b); 

19 (D) by striking subsections (c), (d), and 

20 (e); and 

21 (E) by redesignating subsection (f) (relat22 ing to special enrollment periods) as subsection 

23 (c). 


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1 (2) CLERICAL AMENDMENT.—The item in the 

2 table of sections of chapter 100 of such Code relat3 ing to section 9801 is amended to read as follows: 

‘‘Sec. 9801. Elimination of preexisting condition exclusions.’’. 

4 (c) APPLICATION UNDER PUBLIC HEALTH SERVICE

5 ACT.— 

6 (1) ELIMINATION OF PREEXISTING CONDITION

7 EXCLUSIONS.—Section 2701 of the Public Health 

8 Service Act (42 U.S.C. 300gg) is amended— 

9 (A) by amending the heading to read as 

10 follows: ‘‘ELIMINATION OF PREEXISTING

11 CONDITION EXCLUSIONS’’; 

12 (B) by amending subsection (a) to read as 

13 follows: 

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

15 health insurance issuer offering group health insurance 

16 coverage, with respect to a participant or beneficiary— 

17 ‘‘(1) may not impose any pre-existing condition 

18 exclusion; and 

19 ‘‘(2) in the case of a group health plan that of20 fers medical care through health insurance coverage 

21 offered by a health maintenance organization, may 

22 not provide for an affiliation period with respect to 

23 coverage through the organization.’’; 

24 (C) in subsection (b), by striking para25 graph (3) and inserting the following: 


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1 ‘‘(3) AFFILIATION PERIOD.—The term ‘affili2 ation period’ means a period which, under the terms 

3 of the health insurance coverage offered by the 

4 health maintenance organization, must expire before 

5 the health insurance coverage becomes effective.’’; 

6 (D) by striking subsections (c), (d), (e), 

7 and (g); and 

8 (E) by redesignating subsection (f) (relat9 ing to special enrollment periods) as subsection 

10 (c). 

11 (2) GUARANTEED AVAILABILITY OF GROUP

12 HEALTH INSURANCE COVERAGE TO EMPLOYERS OF

13 ALL SIZES IN THE GROUP MARKET.—Section 2711 

14 of such Act (42 U.S.C. 300gg–11) is amended— 

15 (A) in subsection (a)— 

16 (i) in the heading, by striking 

17 ‘‘SMALL’’; 

18 (ii) in paragraph (1), by striking ‘‘(c) 

19 through (f)’’ and inserting ‘‘(b) through 

20 (d)’’; 

21 (iii) in paragraph (1), in the matter 

22 before subparagraph (A), by striking 

23 ‘‘small’’; 


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1 (iv) in paragraph (1)(A), by striking 

2 ‘‘small employer (as defined in section 

3 2791(e)(4))’’ and inserting ‘‘employer’’; 

4 (v) in paragraph (2), by striking 

5 ‘‘small’’ each place it appears; and 

6 (vi) in paragraph (2), by striking 

7 ‘‘coverage to a’’ and inserting ‘‘coverage to 

8 an’’; 

9 (B) by striking subsection (b); 

10 (C) in subsections (c), (d), and (e), by 

11 striking ‘‘small’’ each place it appears; and 

12 (D) by striking subsection (f). 

13 (3) APPLICATION OF UNIFORM PREMIUMS.— 

14 Section 2711 of such Act, as so amended, is amend15 ed by inserting after subsection (a) the following 

16 new subsection: 

17 ‘‘(b) APPLICATION OF UNIFORM PREMIUM.— 

18 ‘‘(1) IN GENERAL.—Each and every health in19 surance issuer that offers health insurance coverage 

20 in the group market in a State shall— 

21 ‘‘(A) shall charge the same premium price 

22 for the same coverage; and 

23 ‘‘(B) shall openly disclose, in a manner 

24 specified by the Secretary and including disclo25 sure through the Internet, the amount of the 


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1 premium price that is being charged for the 

2 coverage involved. 

3 ‘‘(2) UNIFORM APPLICATION TO FAMILY COV4 ERAGE AND TO DIFFERENT GEOGRAPHIC AREAS.— 

5 Paragraph (1) shall be applied uniformly— 

6 ‘‘(A) for coverage on the basis of such dif7 ferent family categories as the Secretary ap8 proves; and 

9 ‘‘(B) for coverage within each metropolitan 

10 statistical area and for coverage within the por11 tions of a State that are not within a metropoli12 tan statistical area. 

13 ‘‘(3) APPLICATION.—Paragraph (1) shall not be 

14 construed as preventing variations in premiums that 

15 result from the application of a uniform monthly 

16 premium over different policy years.’’. 

17 (4) APPLICATION OF NONDISCRIMINATION

18 RULES TO NONFEDERAL GOVERNMENTAL PLANS.— 

19 Section 2721(b)(2)(A) of such Act (42 U.S.C. 

20 300gg–21(b)(2)(A)) is amended by striking ‘‘sub21 parts 1 through 3’’ and ‘‘such subparts’’ and insert22 ing ‘‘subpart 2’’ and ‘‘such subpart’’, respectively. 

23 (d) EFFECTIVE DATE.— 

24 (1) IN GENERAL.—The amendments made by 

25 this section shall apply to plan years beginning on 


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1 or after January 1, 2009, regardless of whether an 

2 individual is provided coverage under a group health 

3 plan before such date. 

4 (2) SPECIAL RULE FOR COLLECTIVE BAR5 GAINING AGREEMENTS.—In the case of a group 

6 health plan maintained pursuant to one or more col7 lective bargaining agreements between employee rep8 resentatives and one or more employers ratified be9 fore the date of the enactment of this Act, the 

10 amendments made by this section shall not apply to 

11 plan years beginning before the later of— 

12 (A) the date on which the last of the col13 lective bargaining agreements relating to the 

14 plan terminates (determined without regard to 

15 any extension thereof agreed to after the date 

16 of the enactment of this Act), or 

17 (B) January 1, 2010. 

18 For purposes of subparagraph (A), any plan amend19 ment made pursuant to a collective bargaining 

20 agreement relating to the plan which amends the 

21 plan solely to conform to any requirement under the 

22 amendments made by this section shall not be treat23 ed as a termination of such collective bargaining 

24 agreement. 


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1 SEC. 3. NONDISCRIMINATION IN INDIVIDUAL HEALTH IN2 SURANCE. 

3 (a) IN GENERAL.—Section 2741 of the Public Health 

4 Service Act (42 U.S.C. 300gg–41) is amended— 

5 (1) by amending the heading to read as follows: 

6 ‘‘GUARANTEED ISSUE OF INDIVIDUAL HEALTH

7 INSURANCE COVERAGE; UNIFORM PREMIUMS’’; 

8 (2) by amending subsections (a) and (b) to read 

9 as follows: 

10 ‘‘(a) IN GENERAL.— 

11 ‘‘(1) GUARANTEED ISSUE.—Subject to the suc12 ceeding subsections of this section, each and every 

13 health insurance issuer that offers health insurance 

14 coverage (as defined in section 2791(b)(1)) in the in15 dividual market to individuals residing in an area 

16 may not, with respect to an eligible individual (as 

17 defined in subsection (b)) residing in the area who 

18 desires to enroll in individual health insurance cov19 erage— 

20 ‘‘(A) decline to offer such coverage to, or 

21 deny enrollment of, such individual; or 

22 ‘‘(B) impose any preexisting condition ex23 clusion (as defined in section 2701(b)(1)(A)) 

24 with respect to such coverage. 

25 ‘‘(2) APPLICATION OF UNIFORM PREMIUM.— 


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1 ‘‘(A) IN GENERAL.—Each and every health 

2 insurance issuer that offers health insurance 

3 coverage in the individual market in a State— 

4 ‘‘(i) shall charge the same premium 

5 price for the same coverage; 

6 ‘‘(ii) if the issuer offers such coverage 

7 in the group market in the State, shall 

8 charge the same premium for the same 

9 coverage offered in the group market; and 

10 ‘‘(iii) shall openly disclose, in a man11 ner specified by the Secretary and includ12 ing disclosure through the Internet, the 

13 amount of the premium price that is being 

14 charged for the coverage involved. 

15 ‘‘(B) UNIFORM APPLICATION TO FAMILY

16 COVERAGE AND TO DIFFERENT GEOGRAPHIC

17 AREAS.—Subparagraph (A) shall be applied 

18 uniformly— 

19 ‘‘(i) for coverage on the basis of such 

20 different family categories as the Secretary 

21 approves; and 

22 ‘‘(ii) for coverage within each metro23 politan statistical area and for coverage 

24 within the portions of a State that are not 

25 within a metropolitan statistical area. 


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1 ‘‘(C) APPLICATION.—Subparagraph (A) 

2 shall not be construed as preventing variations 

3 in premiums that result from the application of 

4 a uniform monthly premium over different pol5 icy years. 

6 ‘‘(b) ELIGIBLE INDIVIDUAL DEFINED.—In this part, 

7 the term ‘eligible individual’ means, with respect to an 

8 area, an individual who resides in such area, without re9 gard to the period of such residency, and who is— 

10 ‘‘(1) a citizen or national of the United States; 

11 ‘‘(2) an alien lawfully admitted to the United 

12 States for permanent residence; or 

13 ‘‘(3) an alien who is otherwise lawfully residing 

14 in the United States.’’; 

15 (3) by striking subsection (c); 

16 (4) by redesignating subsection (d) and the first 

17 subsection (e) (relating to application of financial ca18 pacity limits) as subsections (c) and (d), respec19 tively; 

20 (5) in paragraph (1) of the subsection (e) relat21 ing to market requirements, by striking ‘‘or through 

22 one or more bona fide associations, or both’’; and 

23 (6) by striking subsection (f) and inserting the 

24 following: 


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1 ‘‘(f) UNIFORM RULES TO RESPOND TO ADVERSE SE2 LECTION.— 

3 ‘‘(1) IN GENERAL.—The Secretary may estab4 lish rules for uniform application that are designed 

5 to deter individuals— 

6 ‘‘(A) from enrolling in individual health in7 surance coverage only after they develop an ill8 ness or injury for which such coverage applies; 

9 and 

10 ‘‘(B) from disenrolling from health insur11 ance coverage for periods in which they are un12 likely (or less likely) to require such coverage. 

13 ‘‘(2) CONSIDERATIONS.—Such rules may take 

14 into account the financial and other circumstances 

15 of individuals for not being so enrolled or for so 

16 disenrolling.’’. 

17 (b) CONFORMING AMENDMENT.—Section 2742(b) of 

18 such Act (42 U.S.C. 300gg–42(b)) is amended by striking 

19 paragraph (5). 

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

21 this section shall apply with respect to health insurance 

22 coverage offered, sold, issued, renewed, in effect, or oper23 ated in the individual market after December 31, 2008. 

Æ 


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