I

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105TH CONGRESS

1ST SESSION H. R. 616

To require that health plans provide coverage for a minimum hospital stay

for mastectomies and lymph node dissection for the treatment of breast

cancer, coverage for reconstructive surgery following mastectomies, and

coverage for secondary consultations.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 5, 1997

Ms. MOLINARI (for herself, Mrs. KELLY, Mr. LOBIONDO, Mr. FLAKE, Mr.

ACKERMAN, Mr. KING, Mrs. MORELLA, Mr. DEAL of Georgia, Mr.

SAXTON, Mr. LAZIO of New York, Mr. SMITH of New Jersey, Mr. FOX

of Pennsylvania, Mr. ANDREWS, Mr. PALLONE, Mr. WALSH, Mr. FROST,

Mr. ENGLISH of Pennsylvania, Mr. WOLF, Mr. MCNULTY, Mrs. ROUKEMA, Mr. FORBES, Mr. SMITH of Washington, Mrs. MCCARTHY of New

York, Ms. SLAUGHTER, Mr. PAPPAS, Mr. FILNER, Mr. HORN, Mr. DAVIS

of Virginia, Mr. MARTINEZ, Mr. WELLER, Mr. GUTIERREZ, Ms. DUNN,

Mr. GILMAN, Mr. SANDERS, Mr. FOLEY, Mr. SHAW, Ms. GRANGER, Mr.

GIBBONS, Ms. CHRISTIAN-GREEN, Mr. OLVER, Ms. STABENOW, Mr. LAFALCE, and Mr. BILBRAY) introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committees

on Ways and Means, and Education and the Workforce, 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 require that health plans provide coverage for a minimum

hospital stay for mastectomies and lymph node dissection

for the treatment of breast cancer, coverage for reconstructive surgery following mastectomies, and coverage

for secondary consultations.
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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 ‘‘Women’s Health and

5 Cancer Rights Act of 1997’’.

6 SEC. 2. FINDINGS.

7 Congress finds that—

8 (1) the offering and operation of health plans

9 affect commerce among the States;

10 (2) health care providers located in a State

11 serve patients who reside in the State and patients

12 who reside in other States; and

13 (3) in order to provide for uniform treatment of

14 health care providers and patients among the States,

15 it is necessary to cover health plans operating in 1

16 State as well as health plans operating among the

17 several States.

18 SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN19 COME SECURITY ACT OF 1974.

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

21 B of title I of the Employee Retirement Income Security

22 Act of 1974 (as added by section 603(a) of the Newborns’

23 and Mothers’ Health Protection Act of 1996 and amended

24 by section 702(a) of the Mental Health Parity Act of
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1 1996) is amended by adding at the end the following new

2 section:

3 ‘‘SEC. 713. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

4 STAY FOR MASTECTOMIES AND LYMPH NODE

5 DISSECTIONS FOR THE TREATMENT OF

6 BREAST CANCER, COVERAGE FOR RECON7 STRUCTIVE SURGERY FOLLOWING

8 MASTECTOMIES, AND COVERAGE FOR SEC9 ONDARY CONSULTATIONS.

10 ‘‘(a) INPATIENT CARE.—

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

12 health insurance issuer providing health insurance

13 coverage in connection with a group health plan,

14 that provides medical and surgical benefits shall en15 sure that inpatient coverage with respect to the

16 treatment of breast cancer is provided for a period

17 of time as is determined by the attending physician,

18 in consultation with the patient, to be medically ap19 propriate following—

20 ‘‘(A) a mastectomy;

21 ‘‘(B) a lumpectomy; or

22 ‘‘(C) a lymph node dissection for the treat23 ment of breast cancer.

24 ‘‘(2) EXCEPTION.—Nothing in this section shall

25 be construed as requiring the provision of inpatient
4

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1 coverage if the attending physician and patient de2 termine that a shorter period of hospital stay is

3 medically appropriate.

4 ‘‘(b) RECONSTRUCTIVE SURGERY.—A group health

5 plan, and a health insurance issuer providing health insur6 ance coverage in connection with a group health plan, that

7 provides medical and surgical benefits with respect to a

8 mastectomy shall ensure that, in a case in which a mastec9 tomy patient elects breast reconstruction, coverage is pro10 vided for—

11 ‘‘(1) all stages of reconstruction of the breast

12 on which the mastectomy has been performed; and

13 ‘‘(2) surgery and reconstruction of the other

14 breast to produce a symmetrical appearance;

15 in the manner determined by the attending physician and

16 the patient to be appropriate, and consistent with any fee

17 schedule contained in the plan.

18 ‘‘(c) PROHIBITION ON CERTAIN MODIFICATIONS.—In

19 implementing the requirements of this section, a group

20 health plan, and a health insurance issuer providing health

21 insurance coverage in connection with a group health plan,

22 may not modify the terms and conditions of coverage

23 based on the determination by a participant or beneficiary

24 to request less than the minimum coverage required under

25 subsection (a) or (b).
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1 ‘‘(d) NOTICE.—A group health plan, and a health in2 surance issuer providing health insurance coverage in con3 nection with a group health plan shall provide notice to

4 each participant and beneficiary under such plan regard5 ing the coverage required by this section in accordance

6 with regulations promulgated by the Secretary. Such no7 tice shall be in writing and prominently positioned in any

8 literature or correspondence made available or distributed

9 by the plan or issuer and shall be transmitted—

10 ‘‘(1) in the next mailing made by the plan or

11 issuer to the participant or beneficiary;

12 ‘‘(2) as part of any yearly informational packet

13 sent to the participant or beneficiary; or

14 ‘‘(3) not later than January 1, 1998;

15 whichever is earlier.

16 ‘‘(e) SECONDARY CONSULTATIONS.—

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

18 health insurance issuer providing health insurance

19 coverage in connection with a group health plan,

20 that provides coverage with respect to medical and

21 surgical services provided in relation to the diagnosis

22 and treatment of cancer shall ensure that full cov23 erage is provided for secondary consultations by spe24 cialists in the appropriate medical fields (including

25 pathology, radiology, and oncology) to confirm or re-
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1 fute such diagnosis. Such plan or issuer shall ensure

2 that full coverage is provided for such secondary

3 consultation whether such consultation is based on a

4 positive or negative initial diagnosis. In any case in

5 which the attending physician certifies in writing

6 that services necessary for such a secondary con7 sultation are not sufficiently available from special8 ists operating under the plan with respect to whose

9 services coverage is otherwise provided under such

10 plan or by such issuer, such plan or issuer shall en11 sure that coverage is provided with respect to the

12 services necessary for the secondary consultation

13 with any other specialist selected by the attending

14 physician for such purpose at no additional cost to

15 the individual beyond that which the individual

16 would have paid if the specialist was participating in

17 the network of the plan.

18 ‘‘(2) EXCEPTION.—Nothing in paragraph (1)

19 shall be construed as requiring the provision of sec20 ondary consultations where the patient determines

21 not to seek such a consultation.

22 ‘‘(f) PROHIBITION ON PENALTIES OR INCENTIVES.—

23 A group health plan, and a health insurance issuer provid24 ing health insurance coverage in connection with a group

25 health plan, may not—
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1 ‘‘(1) penalize or otherwise reduce or limit the

2 reimbursement of a provider or specialist because

3 the provider or specialist provided care to a partici4 pant or beneficiary in accordance with this section;

5 ‘‘(2) provide financial or other incentives to a

6 physician or specialist to induce the physician or

7 specialist to keep the length of inpatient stays of pa8 tients following a mastectomy, lumpectomy, or a

9 lymph node dissection for the treatment of breast

10 cancer below certain limits or to limit referrals for

11 secondary consultations; or

12 ‘‘(3) provide financial or other incentives to a

13 physician or specialist to induce the physician or

14 specialist to refrain from referring a participant or

15 beneficiary for a secondary consultation that would

16 otherwise be covered by the plan or coverage in17 volved under subsection (e).’’.

18 (b) CLERICAL AMENDMENT.—The table of contents

19 in section 1 of such Act, as amended by section 603 of

20 the Newborns’ and Mothers’ Health Protection Act of

21 1996 and section 702 of the Mental Health Parity Act

22 of 1996, is amended by inserting after the item relating

23 to section 712 the following new item:

‘‘Sec. 713. Required coverage for minimum hospital stay for mastectomies and

lymph node dissections for the treatment of breast cancer, coverage for reconstructive surgery following mastectomies, and

coverage for secondary consultations.’’.
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1 (c) EFFECTIVE DATES.—

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

3 this section shall apply with respect to plan years be4 ginning on or after the date of enactment of this

5 Act.

6 (2) SPECIAL RULE FOR COLLECTIVE BARGAIN7 ING AGREEMENTS.—In the case of a group health

8 plan maintained pursuant to 1 or more collective

9 bargaining agreements between employee representa10 tives and 1 or more employers ratified before the

11 date of enactment of this Act, the amendments made

12 by this section shall not apply to plan years begin13 ning before the later of—

14 (A) the date on which the last collective

15 bargaining agreements relating to the plan ter16 minates (determined without regard to any ex17 tension thereof agreed to after the date of en18 actment of this Act), or

19 (B) January 1, 1998.

20 For purposes of subparagraph (A), any plan amend21 ment made pursuant to a collective bargaining

22 agreement relating to the plan which amends the

23 plan solely to conform to any requirement added by

24 this section shall not be treated as a termination of

25 such collective bargaining agreement.
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1 SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE

2 ACT RELATING TO THE GROUP MARKET.

3 (a) IN GENERAL.—Subpart 2 of part A of title

4 XXVII of the Public Health Service Act (as added by sec5 tion 604(a) of the Newborns’ and Mothers’ Health Protec6 tion Act of 1996 and amended by section 703(a) of the

7 Mental Health Parity Act of 1996) is amended by adding

8 at the end the following new section:

9 ‘‘SEC. 2706. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

10 STAY FOR MASTECTOMIES AND LYMPH NODE

11 DISSECTIONS FOR THE TREATMENT OF

12 BREAST CANCER, COVERAGE FOR RECON13 STRUCTION SURGERY FOLLOWING

14 MASTECTOMIES, AND COVERAGE FOR SEC15 ONDARY CONSULTATIONS.

16 ‘‘(a) INPATIENT CARE.—

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

18 health insurance issuer providing health insurance

19 coverage in connection with a group health plan,

20 that provides medical and surgical benefits shall en21 sure that inpatient coverage with respect to the

22 treatment of breast cancer is provided for a period

23 of time as is determined by the attending physician,

24 in consultation with the patient, to be medically ap25 propriate following—

26 ‘‘(A) a mastectomy;
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1 ‘‘(B) a lumpectomy; or

2 ‘‘(C) a lymph node dissection for the treat3 ment of breast cancer.

4 ‘‘(2) EXCEPTION.—Nothing in this section shall

5 be construed as requiring the provision of inpatient

6 coverage if the attending physician and patient de7 termine that a shorter period of hospital stay is

8 medically appropriate.

9 ‘‘(b) RECONSTRUCTIVE SURGERY.—A group health

10 plan, and a health insurance issuer providing health insur11 ance coverage in connection with a group health plan, that

12 provides medical and surgical benefits with respect to a

13 mastectomy shall ensure that, in a case in which a mastec14 tomy patient elects breast reconstruction, coverage is pro15 vided for—

16 ‘‘(1) all stages of reconstruction of the breast

17 on which the mastectomy has been performed; and

18 ‘‘(2) surgery and reconstruction of the other

19 breast to produce a symmetrical appearance;

20 in the manner determined by the attending physician and

21 the patient to be appropriate, and consistent with any fee

22 schedule contained in the plan.

23 ‘‘(c) PROHIBITION ON CERTAIN MODIFICATIONS.—In

24 implementing the requirements of this section, a group

25 health plan, and a health insurance issuer providing health
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1 insurance coverage in connection with a group health plan,

2 may not modify the terms and conditions of coverage

3 based on the determination by a participant or beneficiary

4 to request less than the minimum coverage required under

5 subsection (a) or (b).

6 ‘‘(d) NOTICE.—A group health plan, and a health in7 surance issuer providing health insurance coverage in con8 nection with a group health plan shall provide notice to

9 each participant and beneficiary under such plan regard10 ing the coverage required by this section in accordance

11 with regulations promulgated by the Secretary. Such no12 tice shall be in writing and prominently positioned in any

13 literature or correspondence made available or distributed

14 by the plan or issuer and shall be transmitted—

15 ‘‘(1) in the next mailing made by the plan or

16 issuer to the participant or beneficiary;

17 ‘‘(2) as part of any yearly informational packet

18 sent to the participant or beneficiary; or

19 ‘‘(3) not later than January 1, 1998;

20 whichever is earlier.

21 ‘‘(e) SECONDARY CONSULTATIONS.—

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

23 health insurance issuer providing health insurance

24 coverage in connection with a group health plan that

25 provides coverage with respect to medical and sur-
12

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1 gical services provided in relation to the diagnosis

2 and treatment of cancer shall ensure that full cov3 erage is provided for secondary consultations by spe4 cialists in the appropriate medical fields (including

5 pathology, radiology, and oncology) to confirm or re6 fute such diagnosis. Such plan or issuer shall ensure

7 that full coverage is provided for such secondary

8 consultation whether such consultation is based on a

9 positive or negative initial diagnosis. In any case in

10 which the attending physician certifies in writing

11 that services necessary for such a secondary con12 sultation are not sufficiently available from special13 ists operating under the plan with respect to whose

14 services coverage is otherwise provided under such

15 plan or by such issuer, such plan or issuer shall en16 sure that coverage is provided with respect to the

17 services necessary for the secondary consultation

18 with any other specialist selected by the attending

19 physician for such purpose at no additional cost to

20 the individual beyond that which the individual

21 would have paid if the specialist was participating in

22 the network of the plan.

23 ‘‘(2) EXCEPTION.—Nothing in paragraph (1)

24 shall be construed as requiring the provision of sec-
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1 ondary consultations where the patient determines

2 not to seek such a consultation.

3 ‘‘(f) PROHIBITION ON PENALTIES OR INCENTIVES.—

4 A group health plan, and a health insurance issuer provid5 ing health insurance coverage in connection with a group

6 health plan, may not—

7 ‘‘(1) penalize or otherwise reduce or limit the

8 reimbursement of a provider or specialist because

9 the provider or specialist provided care to a partici10 pant or beneficiary in accordance with this section;

11 ‘‘(2) provide financial or other incentives to a

12 physician or specialist to induce the physician or

13 specialist to keep the length of inpatient stays of pa14 tients following a mastectomy, lumpectomy, or a

15 lymph node dissection for the treatment of breast

16 cancer below certain limits or to limit referrals for

17 secondary consultations; or

18 ‘‘(3) provide financial or other incentives to a

19 physician or specialist to induce the physician or

20 specialist to refrain from referring a participant or

21 beneficiary for a secondary consultation that would

22 otherwise be covered by the plan or coverage in23 volved under subsection (e).’’.

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

2 this section shall apply to group health plans for

3 plan years beginning on or after the date of enact4 ment of this Act.

5 (2) SPECIAL RULE FOR COLLECTIVE BARGAIN6 ING AGREEMENTS.—In the case of a group health

7 plan maintained pursuant to 1 or more collective

8 bargaining agreements between employee representa9 tives and 1 or more employers ratified before the

10 date of enactment of this Act, the amendments made

11 by this section shall not apply to plan years begin12 ning before the later of—

13 (A) the date on which the last collective

14 bargaining agreements relating to the plan ter15 minates (determined without regard to any ex16 tension thereof agreed to after the date of en17 actment of this Act), or

18 (B) January 1, 1998.

19 For purposes of subparagraph (A), any plan amend20 ment made pursuant to a collective bargaining

21 agreement relating to the plan which amends the

22 plan solely to conform to any requirement added by

23 this section shall not be treated as a termination of

24 such collective bargaining agreement.
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1 SEC. 5. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT

2 RELATING TO THE INDIVIDUAL MARKET.

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

4 XXVII of the Public Health Service Act (as added by sec5 tion 605(a) of the Newborn’s and Mother’s Health Protec6 tion Act of 1996) is amended by adding at the end the

7 following new section:

8 ‘‘SEC. 2752. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

9 STAY FOR MASTECTOMIES AND LYMPH NODE

10 DISSECTIONS FOR THE TREATMENT OF

11 BREAST CANCER AND SECONDARY CON12 SULTATIONS.

13 ‘‘The provisions of section 2706 shall apply to health

14 insurance coverage offered by a health insurance issuer

15 in the individual market in the same manner as they apply

16 to health insurance coverage offered by a health insurance

17 issuer in connection with a group health plan in the small

18 or large group market.’’.

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

20 this section shall apply with respect to health insurance

21 coverage offered, sold, issued, renewed, in effect, or oper22 ated in the individual market on or after the date of enact23 ment of this Act.
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1 SEC. 6. AMENDMENTS TO THE INTERNAL REVENUE CODE

2 OF 1986.

3 (a) IN GENERAL.—Chapter 100 of the Internal Reve4 nue Code of 1986 (relating to group health plan port5 ability, access, and renewability requirements) is amended

6 by redesignating sections 9804, 9805, and 9806 as sec7 tions 9805, 9806, and 9807, respectively, and by inserting

8 after section 9803 the following new section:

9 ‘‘SEC. 9804. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

10 STAY FOR MASTECTOMIES AND LYMPH NODE

11 DISSECTIONS FOR THE TREATMENT OF

12 BREAST CANCER, COVERAGE FOR RECON13 STRUCTIVE SURGERY FOLLOWING

14 MASTECTOMIES, AND COVERAGE FOR SEC15 ONDARY CONSULTATIONS.

16 ‘‘(a) INPATIENT CARE.—

17 ‘‘(1) IN GENERAL.—A group health plan that

18 provides medical and surgical benefits shall ensure

19 that inpatient coverage with respect to the treatment

20 of breast cancer is provided for a period of time as

21 is determined by the attending physician, in con22 sultation with the patient, to be medically appro23 priate following—

24 ‘‘(A) a mastectomy;

25 ‘‘(B) a lumpectomy; or
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1 ‘‘(C) a lymph node dissection for the treat2 ment of breast cancer.

3 ‘‘(2) EXCEPTION.—Nothing in this section shall

4 be construed as requiring the provision of inpatient

5 coverage if the attending physician and patient de6 termine that a shorter period of hospital stay is

7 medically appropriate.

8 ‘‘(b) RECONSTRUCTIVE SURGERY.—A group health

9 plan that provides medical and surgical benefits with re10 spect to a mastectomy shall ensure that, in a case in which

11 a mastectomy patient elects breast reconstruction, cov12 erage is provided for—

13 ‘‘(1) all stages of reconstruction of the breast

14 on which the mastectomy has been performed; and

15 ‘‘(2) surgery and reconstruction of the other

16 breast to produce a symmetrical appearance;

17 in the manner determined by the attending physician and

18 the patient to be appropriate, and consistent with any fee

19 schedule contained in the plan.

20 ‘‘(c) PROHIBITION ON CERTAIN MODIFICATIONS.—In

21 implementing the requirements of this section, a group

22 health plan may not modify the terms and conditions of

23 coverage based on the determination by a participant or

24 beneficiary to request less than the minimum coverage re25 quired under subsection (a) or (b).
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1 ‘‘(d) NOTICE.—A group health plan shall provide no2 tice to each participant and beneficiary under such plan

3 regarding the coverage required by this section in accord4 ance with regulations promulgated by the Secretary. Such

5 notice shall be in writing and prominently positioned in

6 any literature or correspondence made available or distrib7 uted by the plan and shall be transmitted—

8 ‘‘(1) in the next mailing made by the plan to

9 the participant or beneficiary;

10 ‘‘(2) as part of any yearly informational packet

11 sent to the participant or beneficiary; or

12 ‘‘(3) not later than January 1, 1998;

13 whichever is earlier.

14 ‘‘(e) SECONDARY CONSULTATIONS.—

15 ‘‘(1) IN GENERAL.—A group health plan that

16 provides coverage with respect to medical and sur17 gical services provided in relation to the diagnosis

18 and treatment of cancer shall ensure that full cov19 erage is provided for secondary consultations by spe20 cialists in the appropriate medical fields (including

21 pathology, radiology, and oncology) to confirm or re22 fute such diagnosis. Such plan or issuer shall ensure

23 that full coverage is provided for such secondary

24 consultation whether such consultation is based on a

25 positive or negative initial diagnosis. In any case in
19

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1 which the attending physician certifies in writing

2 that services necessary for such a secondary con3 sultation are not sufficiently available from special4 ists operating under the plan with respect to whose

5 services coverage is otherwise provided under such

6 plan or by such issuer, such plan or issuer shall en7 sure that coverage is provided with respect to the

8 services necessary for the secondary consultation

9 with any other specialist selected by the attending

10 physician for such purpose at no additional cost to

11 the individual beyond that which the individual

12 would have paid if the specialist was participating in

13 the network of the plan.

14 ‘‘(2) EXCEPTION.—Nothing in paragraph (1)

15 shall be construed as requiring the provision of sec16 ondary consultations where the patient determines

17 not to seek such a consultation.

18 ‘‘(f) PROHIBITION ON PENALTIES.—A group health

19 plan may not—

20 ‘‘(1) penalize or otherwise reduce or limit the

21 reimbursement of a provider or specialist because

22 the provider or specialist provided care to a partici23 pant or beneficiary in accordance with this section;

24 ‘‘(2) provide financial or other incentives to a

25 physician or specialist to induce the physician or
20

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1 specialist to keep the length of inpatient stays of pa2 tients following a mastectomy, lumpectomy, or a

3 lymph node dissection for the treatment of breast

4 cancer below certain limits or to limit referrals for

5 secondary consultations; or

6 ‘‘(3) provide financial or other incentives to a

7 physician or specialist to induce the physician or

8 specialist to refrain from referring a participant or

9 beneficiary for a secondary consultation that would

10 otherwise be covered by the plan involved under sub11 section (e).’’.

12 (b) CONFORMING AMENDMENTS.—

13 (1) Sections 9801(c)(1), 9805(b) (as redesig14 nated by subsection (a)), 9805(c) (as so redesig15 nated), 4980D(c)(3)(B)(i)(I), 4980D(d)(3), and

16 4980D(f)(1) of such Code are each amended by

17 striking ‘‘9805’’ each place it appears and inserting

18 ‘‘9806’’.

19 (2) The heading for subtitle K of such Code is

20 amended to read as follows:

21 ‘‘Subtitle K—Group Health Plan

22 Portability, Access, Renewabil23 ity, and Other Requirements’’.

24 (3) The heading for chapter 100 of such Code

25 is amended to read as follows:
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1 ‘‘CHAPTER 100—GROUP HEALTH PLAN PORT2 ABILITY, ACCESS, RENEWABILITY, AND

3 OTHER REQUIREMENTS’’.

4 (4) Section 4980D(a) of such Code is amended

5 by striking ‘‘and renewability’’ and inserting ‘‘renew6 ability, and other’’.

7 (c) CLERICAL AMENDMENTS.—

8 (1) The table of contents for chapter 100 of

9 such Code is amended by redesignating the items re10 lating to sections 9804, 9805, and 9806 as items re11 lating to sections 9805, 9806, and 9807, and by in12 serting after the item relating to section 9803 the

13 following new item:

‘‘Sec. 9804. Required coverage for minimum hospital stay for mastectomies and

lymph node dissections for the treatment of breast cancer, coverage for reconstructive surgery following mastectomies, and

coverage for secondary consultations.’’.

14 (2) The item relating to subtitle K in the table

15 of subtitles for such Code is amended by striking

16 ‘‘and renewability’’ and inserting ‘‘renewability, and

17 other’’.

18 (3) The item relating to chapter 100 in the

19 table of chapters for subtitle K of such Code is

20 amended by striking ‘‘and renewability’’ and insert21 ing ‘‘renewability, and other’’.

22 (d) EFFECTIVE DATES.—
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1 (1) IN GENERAL.—The amendments made by

2 this section shall apply with respect to plan years be3 ginning on or after the date of enactment of this

4 Act.

5 (2) SPECIAL RULE FOR COLLECTIVE BARGAIN6 ING AGREEMENTS.—In the case of a group health

7 plan maintained pursuant to 1 or more collective

8 bargaining agreements between employee representa9 tives and 1 or more employers ratified before the

10 date of enactment of this Act, the amendments made

11 by this section shall not apply to plan years begin12 ning before the later of—

13 (A) the date on which the last collective

14 bargaining agreements relating to the plan ter15 minates (determined without regard to any ex16 tension thereof agreed to after the date of en17 actment of this Act), or

18 (B) January 1, 1998.

19 For purposes of subparagraph (A), any plan amend20 ment made pursuant to a collective bargaining

21 agreement relating to the plan which amends the

22 plan solely to conform to any requirement added by

23 this section shall not be treated as a termination of

24 such collective bargaining agreement.

Æ