I

104TH CONGRESS

2D SESSION H. R. 3590

To prevent discrimination against victims of domestic abuse in all lines

of insurance and in group health plans.

IN THE HOUSE OF REPRESENTATIVES

JUNE 5, 1996

Mr. POMEROY introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committee on Economic and

Educational Opportunities, for a period to be subsequently determined by

the Speaker, in each case for consideration of such provisions as fall within the jurisidiction of the committee concerned

A BILL

To prevent discrimination against victims of domestic abuse

in all lines of insurance and in group health plans.

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 ‘‘Victims of Domestic

5 Abuse Insurance Protection Act of 1996’’.

6 SEC. 2. DEFINITIONS.

7 As used in this Act:

8 (1) The term ‘‘domestic abuse’’ means the oc9 currence of one or more of the following acts be-
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1 tween former or current household or family mem2 bers (including in-laws or extended family), spouses

3 or former spouses, individuals engaged in or for4 merly engaged in a sexually intimate relationship, a

5 caretaker and the person taken care of, a perpetra6 tor of sexual assault and the victim of the assault,

7 or a stalker or a sex offender in relation to the per8 son being stalked or person against whom the of9 fense was or is being committed:

10 (A) Attempting to cause or intentionally,

11 knowingly, or recklessly causing the other per12 son bodily injury, physical harm, severe emo13 tional distress, psychological trauma, rape, sex14 ual assault, or involuntary sexual intercourse.

15 (B) Engaging in a course of conduct or re16 peatedly committing acts toward the other per17 son, including following the person without

18 proper authority and under circumstances that

19 place the person in reasonable fear of bodily in20 jury or physical harm.

21 (C) Subjecting the other person to false

22 imprisonment or kidnapping.

23 (D) Attempting to cause or intentionally,

24 knowingly, or recklessly causing damage to
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1 property so as to intimidate or attempt to con2 trol the behavior of the other person.

3 (2) The term ‘‘domestic abuse-related medical

4 condition’’ means a medical condition sustained by

5 the subject of domestic abuse which arises in whole

6 or in part out of an action or pattern of domestic

7 abuse in relation to the subject of domestic abuse.

8 (3) The term ‘‘domestic abuse status’’ means

9 the fact or perception that a person is, has been, or

10 may be a subject of domestic abuse, irrespective of

11 whether the person has sustained domestic abuse-re12 lated medical conditions.

13 (4) The term ‘‘insurance policy’’ means any pol14 icy, contract, or certificate of insurance (whether for

15 health benefits, life insurance benefits, property and

16 casualty benefits, or otherwise) issued by an insurer

17 and subject to the insurance laws and regulations of

18 a State, and includes an endorsement or rider to

19 such a policy, contract, or certificate and includes a

20 contract of health benefits issued by a health main21 tenance organization.

22 (5) The term ‘‘insured’’ means a party named

23 on an insurance policy as the person with legal

24 rights to the benefits provided by the policy. For
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1 group insurance, such term includes a person who is

2 a beneficiary covered by a group policy or certificate.

3 (6) The term ‘‘insurer’’ means any person or

4 legal entity (including a health carrier or life, dis5 ability, and property and casualty insurer) engaged

6 in the business of insurance and subject to the in7 surance laws and regulations of a State, and in8 cludes agents, brokers, adjusters, and third party

9 administrators and includes health maintenance or10 ganizations and similar organizations subject to reg11 ulation by a State for insolvency.

12 (7) The term ‘‘subject of domestic abuse’’

13 means—

14 (A) a person to whom an act of domestic

15 abuse is directed,

16 (B) a person who has had prior or current

17 injuries, illnesses, or disorders that resulted

18 from domestic abuse, or

19 (C) a person who seeks, may have sought,

20 or had reason to seek—

21 (i) medical or psychological treatment

22 for domestic abuse, or

23 (ii) protection (including court-order

24 protection) or shelter from domestic abuse.
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1 (8) The term ‘‘group health plan’’ has the

2 meaning given such term in section 607(1) of the

3 Employee Retirement Income Security Act of 1974

4 (29 U.S.C. 1167(1)).

5 (9) The terms ‘‘beneficiary’’ and ‘‘participant’’

6 have the meanings given such terms in section 3 of

7 the Employee Retirement Income Security Act of

8 1974.

9 SEC. 3. PROHIBITION OF UNFAIR DISCRIMINATION

10 AGAINST SUBJECTS OF DOMESTIC ABUSE.

11 (a) IN GENERAL.—An insurer or group health plan

12 may not, directly or indirectly, engage in any of the follow13 ing acts or practices on the basis that the applicant or

14 insured, or any person employed by the applicant or in15 sured or with whom the applicant or insured is known to

16 have a relationship or association, or a beneficiary or par17 ticipant in the plan is, has been, or may be the subject

18 of domestic abuse:

19 (1) Denying, refusing to issue, renew or reissue,

20 or canceling or otherwise terminating an insurance

21 policy or coverage under the group health plan; or

22 restricting or excluding coverage under the policy or

23 plan; or adding a premium differential to any insur24 ance policy or for coverage under the plan on such

25 basis.
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1 (2) Excluding or limiting coverage for losses or

2 denying a claim incurred by an insured or partici3 pant or beneficiary as a result of domestic abuse on

4 the basis of the insured’s, participant’s, or bene5 ficiary’s abuse status, except (in the case of an in6 surer) as otherwise permitted or required by State

7 laws relating to acts of abuse committed by life in8 surance beneficiaries.

9 (3)(A) Subject to subparagraph (B), terminat10 ing coverage for a subject of domestic abuse because

11 coverage was originally issued or provided in the

12 name of the abuser and the abuser has divorced,

13 separated from, or lost custody of the subject of do14 mestic abuse or the abuser’s coverage has termi15 nated voluntarily or involuntarily and, with respect

16 to health insurance coverage or coverage under a

17 group health plan, the subject of domestic abuse

18 does not qualify for extension of coverage under part

19 6 of subtitle B of title I or the Employee Retirement

20 Income Security Act of 1974, section 4980B of the

21 Internal Revenue Code of 1986, or title XXII of the

22 Public Health Service Act.

23 (B) Nothing in subparagraph (A) prohibits the

24 insurer or group health plan from requiring the sub25 ject of domestic abuse to pay the full premium for
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1 the subject’s coverage under the policy or plan or

2 from requiring, as a condition of health insurance

3 coverage or coverage under the plan, that the subject

4 of domestic abuse reside or work within its service

5 area if such requirements are applied to all insureds

6 of the insurer with respect to such coverage or to all

7 participants and beneficiaries.

8 (C) The insurer may terminate group health in9 surance coverage after the continuation coverage re10 quired by this paragraph has been in force for 18

11 months if it offers conversion to an equivalent indi12 vidual plan.

13 (D) The continuation of health coverage re14 quired by this paragraph shall be satisfied by cov15 erage under part 6 of subtitle B of title I or the Em16 ployee Retirement Income Security Act of 1974 (29

17 U.S.C. 1161 et seq.), section 4980B of the Internal

18 Revenue Code of 1986, or title XXII of the Public

19 Health Service Act provided to a subject of domestic

20 abuse and is not intended to be in addition to any

21 extension of coverage provided under such part, sec22 tion, or title.

23 (b) LIMITATION ON USE OR TRANSFER OF INFORMA24 TION.—
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1 (1) IN GENERAL.—An insurer or group health

2 plan (or a contractor with an insurer or group

3 health plan) may not use, disclose, or transfer infor4 mation relating to an individual’s abuse status, or

5 medical condition which the insurer or plan knows or

6 has reason to know is abuse-related, or an individ7 ual’s family, household, social, or employment rela8 tionship with a subject of domestic abuse except to

9 the extent necessary for the direct provision of

10 health care services, compliance with abuse reporting

11 laws, or (in the case of an insurer) compliance with

12 an order of an entity with authority to regulate in13 surance or an order of a court of competent jurisdic14 tion. Nothing in this paragraph shall be construed

15 as limiting or precluding a subject of domestic abuse

16 from obtaining the subject’s own medical records

17 from an insurer or group health plan.

18 (2) ACCESS TO INFORMATION BY SUBJECT OF

19 DOMESTIC ABUSE.—A subject of domestic abuse

20 may provide evidence of domestic abuse to an in21 surer or group health plan for the limited purpose

22 of facilitating treatment of an domestic abuse-relat23 ed condition or demonstrating that a condition is do24 mestic abuse-related. Nothing in this paragraph
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1 shall be construed as authorizing an insurer or plan

2 to disregard such provided evidence.

3 SEC. 4. EXPLANATION OF REASONS FOR ADVERSE AC4 TIONS.

5 An insurer or group health plan that takes any ad6 verse action relating to any insurance policy or coverage

7 under a group health plan of a subject of domestic abuse

8 on the basis of a claim or medical condition that the in9 surer or plan knows or has reason to know is abuse-relat10 ed, shall explain the reason for its action to the applicant

11 or insured or individual in writing. Reference to general

12 underwriting practices or guidelines does not constitute a

13 specific reason.

14 SEC. 5. SPECIAL RULE FOR LIFE INSURANCE.

15 Nothing in this Act shall be construed to prohibit a

16 life insurer from declining to issue a life insurance policy

17 on the life of an individual if the applicant or prospective

18 owner of the policy is or would be designated as a bene19 ficiary of the policy, and if—

20 (1) the applicant or prospective owner of the

21 policy lacks an insurable interest in the insured; or

22 (2) the applicant or prospective owner of the

23 policy is known, on the basis of police or court

24 records, to have committed an act of domestic abuse

25 in relation to the individual.
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1 SEC. 6. SUBROGATION WITHOUT CONSENT PROHIBITED.

2 Except where the subject of domestic abuse has al3 ready recovered damages, subrogation of claims resulting

4 from domestic abuse is prohibited without the informed

5 consent of the subject of domestic abuse.

6 SEC. 7. COMPLIANCE WITH INSURANCE PROTOCOLS FOR

7 SUBJECTS OF DOMESTIC ABUSE.

8 An insurer shall develop, file with the applicable regu9 latory authority, and adhere to, protocols specifying how

10 employees, contractors, agents, and broker of the insurer

11 will pursue an insurance action (including claims inves12 tigation and subrogation) that may impact the safety of

13 a subject of domestic abuse involved with that action.

14 SEC. 8. ESTABLISHMENT OF STANDARDS FOR INSURERS.

15 (a) IN GENERAL.—If, within the 90-day period begin16 ning on the date of the enactment of this Act, the National

17 Association of Insurance Commissioners adopts a Model

18 Act and Regulations that establish standards for insurers

19 with respect to the requirements under this Act, such

20 standards shall apply to insurers in carrying out this Act.

21 (b) FALLBACK FEDERAL STANDARDS.—If the NAIC

22 does not adopt such an Act and Regulations within the

23 period specified in subsection (a), the Secretary of Health

24 and Human Services shall promulgate, not later than 60

25 days after the end of such period, standards for insurers

26 to carry out this Act.
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1 SEC. 9. ENFORCEMENT FOR INSURERS.

2 (a) STATE ENFORCEMENT.—

3 (1) IN GENERAL.—Each State may establish

4 under State law a regulatory program that provides

5 for the application and enforcement of standards for

6 insurers equal to or more stringent than the stand7 ards established under section 8 to carry out this

8 Act.

9 (2) REVIEW.—The Secretary periodically shall

10 review State regulatory programs to determine if

11 they continue to substantially meet the requirements

12 specified in paragraph (1). If the Secretary finds

13 that a State regulatory program no longer substan14 tially meets the requirements, before making a final

15 determination, the Secretary shall provide the State

16 an opportunity to adopt such a plan of correction as

17 would permit the State regulatory program to con18 tinue to meet such requirements. If the Secretary

19 makes a final determination that the State regu20 latory program, after such an opportunity, fails to

21 substantially meet such requirements, the provisions

22 of subsection (b) shall apply to insurers in that

23 State.

24 (b) FEDERAL FALLBACK ENFORCEMENT.—In the

25 case of an insurer, with respect to insurance policies issued

26 in a State which does not have an approved regulatory
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1 program in effect under subsection (a)(1), that the Sec2 retary of Health and Human Services determines fails to

3 comply with an applicable standard established under sec4 tion 8, the insurer is subject to a civil money penalty of

5 not to exceed $25,000 for each such violation. The provi6 sions of section 1128A of the Social Security Act (other

7 than the first sentence of subsection (a) and other than

8 subsection (b)) shall apply to a civil money penalty under

9 the previous sentence in the same manner as such provi10 sions apply to a penalty or proceeding under section

11 1128A(a) of such Act.

12 SEC. 10. ENFORCEMENT WITH RESPECT TO GROUP

13 HEALTH PLANS.

14 The provisions of this Act insofar as they relate to

15 group health plans shall be deemed to be provisions of title

16 I of the Employee Retirement Income Security Act of

17 1974 for purposes of applying such title. With respect to

18 group health plans, the Secretary of Labor shall enforce

19 the requirements of this Act in the same manner as pro20 vided for under sections 502, 504, 506, and 510 of the

21 Employee Retirement Income Security Act of 1974 (29

22 U.S.C. 1132, 1134, 1136, and 1140).

23 SEC. 11. EFFECTIVE DATE.

24 (a) IN GENERAL.—Subject to subsection (b), the re25 quirements of this Act shall take effect on July 1, 1997,
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1 or, in the case of insurers and if later, the date specified

2 in subsection (b), and shall apply to actions occurring on

3 or after such date.

4 (b) SPECIAL RULE.—In the case of a State which the

5 Secretary of Health and Human Services identifies as—

6 (1) requiring State legislation (other than legis7 lation appropriating funds) in order for insurance

8 policies to meet standards established under section

9 8 or for the State insurance commissioner to per10 form the functions described in section 9(a), but

11 (2) having a legislature which is not scheduled

12 to meet in 1997 in a legislative session in which

13 such legislation may be considered,

14 the date specified in this subsection is the first day of the

15 first calendar quarter beginning after the close of the first

16 legislative session of the State legislature that begins on

17 or after the date of the enactment of this Act, and in

18 which legislation described in paragraph (1) may be con19 sidered. For purposes of the previous sentence, in the case

20 of a State that has a 2-year legislative session, each year

21 of such session shall be deemed to be a separate regular

22 session of the State legislature.

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