I

104TH CONGRESS

2D SESSION H. R. 4300

To amend the Public Health Service Act to assure the availability of health

insurance coverage for children in the individual market in a manner

similar to guaranteed availability of individual health insurance coverage

for certain previously covered individuals under the Health Insurance

Portability and Accountability Act of 1996.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 28, 1996

Ms. FURSE introduced the following bill; which was referred to the Committee

on Commerce

A BILL

To amend the Public Health Service Act to assure the availability of health insurance coverage for children in the

individual market in a manner similar to guaranteed

availability of individual health insurance coverage for

certain previously covered individuals under the Health

Insurance Portability and Accountability Act of 1996.

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 ‘‘Children Health Insur5 ance Access Amendments of 1996’’.
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1 SEC. 2. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

2 (a) IN GENERAL.—Title XXVII of the Public Health

3 Service Act, as added by section 111(a) of the Health In4 surance Portability and Accountability Act of 1996, is

5 amended by inserting after section 2741 the following new

6 section:

7 ‘‘SEC. 2741A. GUARANTEED AVAILABILITY OF INDIVIDUAL

8 HEALTH INSURANCE COVERAGE TO UNIN9 SURED CHILDREN.

10 ‘‘(a) GUARANTEED AVAILABILITY.—

11 ‘‘(1) IN GENERAL.—Subject to the succeeding

12 subsections of this section, each health insurance is13 suer that offers health insurance coverage (as de14 fined in section 2791(b)(1)) in the individual market

15 in a State, in the case of an eligible child (as defined

16 in subsection (b)) desiring to enroll in individual

17 health insurance coverage—

18 ‘‘(A) may not decline to offer such cov19 erage to, or deny enrollment of, such child;

20 ‘‘(B) either (i) does not impose any pre21 existing condition exclusion (as defined in sec22 tion 2701(b)(1)(A)) with respect to such cov23 erage, or (ii) imposes such a preexisting condi24 tion exclusion only to the extent such an exclu25 sion may be imposed under section 2701(a) in
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1 the case of an individual who is not a late en2 rollee; and

3 ‘‘(C) shall provide that the premium for

4 the coverage is determined in a manner so that

5 the ratio of the premium for such eligible chil6 dren to the premium for eligible individuals de7 scribed in section 2741(b) does not exceed the

8 ratio of the actuarial value of such coverage

9 (calculated based on a standardized population

10 and a set of standardized utilization and cost

11 factors) for children to such actuarial value for

12 such coverage for such eligible individuals.

13 ‘‘(2) SUBSTITUTION BY STATE OF ACCEPTABLE

14 ALTERNATIVE MECHANISM.—The requirement of

15 paragraph (1) shall not apply to health insurance

16 coverage offered in the individual market in a State

17 in which the State is implementing an acceptable al18 ternative mechanism under section 2744.

19 ‘‘(b) ELIGIBLE CHILD DEFINED.—In this part, the

20 term ‘eligible child’ means an individual born after Sep21 tember 30, 1983, who has not attained 16 years of age

22 and—

23 ‘‘(1) who is a citizen or national of the United

24 States, an alien lawfully admitted for permanent res-
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1 idence, or an alien otherwise permanently residing in

2 the United States under color of law;

3 ‘‘(2) who is not eligible for coverage under (A)

4 a group health plan, (B) part A or part B of title

5 XVIII of the Social Security Act, or (C) a State plan

6 under title XIX of such Act (or any successor pro7 gram), and does not have other health insurance

8 coverage; and

9 ‘‘(3) with respect to whom the most recent cov10 erage (if any, within the 1-year period ending on the

11 date coverage is sought under this section) was not

12 terminated based on a factor described in paragraph

13 (1) or (2) of section 2712(b) (relating to nonpay14 ment of premiums or fraud).

15 For purposes of paragraph (2)(A), the term ‘group health

16 plan’ does not include COBRA continuation coverage.

17 ‘‘(c) INCORPORATION OF CERTAIN PROVISIONS.—

18 ‘‘(1) IN GENERAL.—Subject to paragraph (2),

19 the provisions of subsections (c), (d), (e) and (f)

20 (other than paragraph (1)) of section 2741 and sec21 tion 2744 shall apply in relation to eligible children

22 under subsection (a) in the same manner as they

23 apply in relation to eligible individuals under section

24 2741(a).
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1 ‘‘(2) SPECIAL RULES FOR ACCEPTABLE ALTER2 NATIVE MECHANISMS.—With respect to applying

3 section 2744 under paragraph (1)—

4 ‘‘(A) the requirement in subsection

5 (a)(1)(B) shall be applied instead of the re6 quirement of section 2744(a)(1)(B);

7 ‘‘(B) the requirement in subsection

8 (a)(1)(C) shall be applied instead of the re9 quirement of section 2744(a)(1)(D); and

10 ‘‘(C) any deadline specified in such section

11 shall be 6 months after the deadline otherwise

12 specified.’’.

13 (b) EFFECTIVE DATE.—The amendment made by

14 subsection (a) shall take effect as if included in the enact15 ment of section 2741 of the Public Health Service Act

16 under section 111(a) of the Health Insurance Portability

17 and Accountability Act of 1996.

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