I 

113TH CONGRESS 

2D SESSION H. R. 5328 

To amend the Public Health Service Act to prohibit application of preexisting 

condition exclusions and to guarantee availability of health insurance 

coverage in the individual and group market, contingent on the enactment 

of legislation repealing the Patient Protection and Affordable Care Act, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2014 

Mr. COFFMAN (for himself, Mr. PEARCE, and Mr. VALADAO) introduced the 

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

A BILL 

To amend the Public Health Service Act to prohibit application of preexisting condition exclusions and to guarantee 

availability of health insurance coverage in the individual 

and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable 

Care Act, 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 ‘‘Guaranteed Health 

5 Coverage for Pre-Existing Conditions Act of 2014’’. 

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1 SEC. 2. PROHIBITION OF PREEXISTING CONDITION EXCLU2 SIONS. 

3 (a) GROUP MARKET.—Subpart 1 of part A of title 

4 XXVII of the Public Health Service Act (42 U.S.C. 300gg 

5 et seq.) is amended by striking section 2701 and inserting 

6 the following: 

7 ‘‘SEC. 2701. PROHIBITION OF PREEXISTING CONDITION EX8 CLUSIONS. 

9 ‘‘(a) IN GENERAL.—A group health plan or a health 

10 insurance issuer offering group health insurance coverage 

11 may not impose any preexisting condition exclusion with 

12 respect to such plan or coverage. 

13 ‘‘(b) DEFINITIONS.—For purposes of this section: 

14 ‘‘(1) PREEXISTING CONDITION EXCLUSION.— 

15 ‘‘(A) IN GENERAL.—The term ‘preexisting 

16 condition exclusion’ means, with respect to a 

17 group health plan or health insurance coverage, 

18 a limitation or exclusion of benefits relating to 

19 a condition based on the fact that the condition 

20 was present before the date of enrollment in 

21 such plan or for such coverage, whether or not 

22 any medical advice, diagnosis, care, or treat23 ment was recommended or received before such 

24 date. 

25 ‘‘(B) TREATMENT OF GENETIC INFORMA26 TION.—Genetic information shall not be treated 

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1 as a preexisting condition in the absence of a 

2 diagnosis of the condition related to such infor3 mation. 

4 ‘‘(2) DATE OF ENROLLMENT.—The term ‘date 

5 of enrollment’ means, with respect to an individual 

6 covered under a group health plan or health insur7 ance coverage, the date of enrollment of the indi8 vidual in the plan or coverage or, if earlier, the first 

9 day of the waiting period for such enrollment. 

10 ‘‘(3) WAITING PERIOD.—The term ‘waiting pe11 riod’ means, with respect to a group health plan and 

12 an individual who is a potential participant or bene13 ficiary in the plan, the period that must pass with 

14 respect to the individual before the individual is eli15 gible to be covered for benefits under the terms of 

16 the plan.’’. 

17 (b) INDIVIDUAL MARKET.—Subpart 1 of part B of 

18 title XXVII of the Public Health Service Act (42 U.S.C. 

19 300gg–41 et seq.) is amended by adding at the end the 

20 following: 

21 ‘‘SEC. 2746. PROHIBITION OF PREEXISTING CONDITION EX22 CLUSIONS OR OTHER DISCRIMINATION 

23 BASED ON HEALTH STATUS. 

24 ‘‘The provisions of section 2701 shall apply to health 

25 insurance coverage offered to individuals by a health inmstockstill on DSK4VPTVN1PROD with BILLS

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1 surance issuer in the individual market in the same man2 ner as it applies to health insurance coverage offered by 

3 a health insurance issuer in the group market.’’. 

4 SEC. 3. GUARANTEED AVAILABILITY OF COVERAGE. 

5 (a) GROUP MARKET.—Subpart 3 of part A of title 

6 XXVII of the Public Health Service Act is amended by 

7 striking section 2711 (42 U.S.C. 300gg–11) and inserting 

8 the following: 

9 ‘‘SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE. 

10 ‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE

11 GROUP MARKET.—Subject to subsection (b), each health 

12 insurance issuer that offers health insurance coverage in 

13 the group market in a State shall accept every employer 

14 and every individual in a group in the State that applies 

15 for such coverage. 

16 ‘‘(b) ENROLLMENT.— 

17 ‘‘(1) RESTRICTION.—A health insurance issuer 

18 described in subsection (a) may restrict enrollment 

19 in coverage described in such subsection to open or 

20 special enrollment periods. 

21 ‘‘(2) ESTABLISHMENT.—A health insurance 

22 issuer described in subsection (a) shall establish spe23 cial enrollment periods for qualifying events (as such 

24 term is defined in section 603 of the Employee Re25 tirement Income Security Act of 1974).’’. 

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1 (b) INDIVIDUAL MARKET.—Subpart 1 of part B of 

2 title XXVII of the Public Health Service Act is amended 

3 by striking section 2741 of such Act (42 U.S.C. 300gg– 

4 41) and inserting the following: 

5 ‘‘SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE. 

6 ‘‘The provisions of section 2711 shall apply to health 

7 insurance coverage offered to individuals by a health in8 surance issuer in the individual market in the same man9 ner as such provisions apply to health insurance coverage 

10 offered to employers by a health insurance issuer in con11 nection with health insurance coverage in the group mar12 ket. For purposes of this section, the Secretary shall treat 

13 any reference of the word ‘employer’ in such section as 

14 a reference to the term ‘individual’.’’. 

15 SEC. 4. EFFECTIVE DATE CONTINGENT ON REPEAL OF 

16 PPACA. 

17 (a) IN GENERAL.—Sections 2 and 3 and the amend18 ments made by such section shall take effect upon the en19 actment of PPACA repeal legislation described in sub20 section (b) and such sections and amendments shall have 

21 no force or effect if such PPACA repeal legislation is not 

22 enacted. 

23 (b) PPACA REPEAL LEGISLATION DESCRIBED.— 

24 For purposes of subsection (a), PPACA repeal legislation 

25 described in this subsection is legislation that— 

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1 (1) repeals Public Law 111–148, and restores 

2 or revives the provisions of law amended or repealed, 

3 respectively, by such Act as if such Act had not been 

4 enacted and without further amendment to such 

5 provisions of law; and 

6 (2) repeals title I and subtitle B of title II of 

7 the Health Care and Education Reconciliation Act of 

8 2010 (Public Law 111–152), and restores or revives 

9 the provisions of law amended or repealed, respec10 tively, by such title or subtitle, respectively, as if 

11 such title and subtitle had not been enacted and 

12 without further amendment to such provisions of 

13 law. 

Æ 

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