I 
111TH CONGRESS 
1ST SESSION H. R. 1092 
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 13, 2009 
Mr. KAGEN introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committees on Edu-
cation and Labor and Ways and Means, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; PURPOSE. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘No Discrimination in Health Insurance Act of 2009’’. 
(b) PURPOSE.—It is the purpose of this Act to— 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
(1) eliminate the application of pre-existing con-
dition exclusions in all group health coverage policies 
and all individual health insurance policies; and 
(2) provide that all health insurance issuers de-
termine and openly disclose the premium price for 
each and every group health insurance policy and 
each and every individual health insurance policy, 
such that within a specific metropolitan statistical 
area, or other geographic area, all such premiums 
and prices established by a given issuer shall be uni-
form. 
SEC. 2. NONDISCRIMINATION IN GROUP HEALTH COV-
ERAGE. 
(a) APPLICATION UNDER THE EMPLOYEE RETIRE-
MENT INCOME SECURITY ACT OF 1974.— 
(1) ELIMINATION OF PREEXISTING CONDITION 
EXCLUSIONS.—Section 701 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1181) 
is amended— 
(A) by amending the heading to read as 
follows: ‘‘ELIMINATION
OF
PREEXISTING 
CONDITION EXCLUSIONS’’; 
(B) by amending subsection (a) to read as 
follows: 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, with respect to a participant or beneficiary— 
‘‘(1) may not impose any pre-existing condition 
exclusion; and 
‘‘(2) in the case of a group health plan that of-
fers medical care through health insurance coverage 
offered by a health maintenance organization, may 
not provide for an affiliation period with respect to 
coverage through the organization.’’; 
(C) in subsection (b), by striking para-
graph (3) and inserting the following: 
‘‘(3) AFFILIATION
PERIOD.—The term ‘affili-
ation period’ means a period which, under the terms 
of the health insurance coverage offered by the 
health maintenance organization, must expire before 
the health insurance coverage becomes effective.’’; 
(D) by striking subsections (c), (d), (e), 
and (g); and 
(E) by redesignating subsection (f) (relat-
ing to special enrollment periods) as subsection 
(c). 
(2) CLERICAL AMENDMENT.—The item in the 
table of contents of such Act relating to section 701 
is amended to read as follows: 
‘‘Sec. 701. Elimination of pre-existing condition exclusions.’’. 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6211
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
(b) APPLICATION UNDER THE INTERNAL REVENUE 
CODE OF 1986.— 
(1) ELIMINATION OF PREEXISTING CONDITION 
EXCLUSIONS.—Section 9801 of the Internal Revenue 
Code of 1986 is amended— 
(A) by amending the heading to read as 
follows: ‘‘ELIMINATION
OF
PREEXISTING 
CONDITION EXCLUSIONS’’; 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) IN GENERAL.—A group health plan with respect 
to a participant or beneficiary may not impose any pre- 
existing condition exclusion.’’; 
(C) by striking paragraph (3) of subsection 
(b); 
(D) by striking subsections (c), (d), and 
(e); and 
(E) by redesignating subsection (f) (relat-
ing to special enrollment periods) as subsection 
(c). 
(2) CLERICAL AMENDMENT.—The item in the 
table of sections of chapter 100 of such Code relat-
ing to section 9801 is amended to read as follows: 
‘‘Sec. 9801. Elimination of preexisting condition exclusions.’’. 
(c) APPLICATION UNDER PUBLIC HEALTH SERVICE 
ACT.— 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
(1) ELIMINATION OF PREEXISTING CONDITION 
EXCLUSIONS.—Section 2701 of the Public Health 
Service Act (42 U.S.C. 300gg) is amended— 
(A) by amending the heading to read as 
follows: ‘‘ELIMINATION
OF
PREEXISTING 
CONDITION EXCLUSIONS’’; 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, with respect to a participant or beneficiary— 
‘‘(1) may not impose any pre-existing condition 
exclusion; and 
‘‘(2) in the case of a group health plan that of-
fers medical care through health insurance coverage 
offered by a health maintenance organization, may 
not provide for an affiliation period with respect to 
coverage through the organization.’’; 
(C) in subsection (b), by striking para-
graph (3) and inserting the following: 
‘‘(3) AFFILIATION
PERIOD.—The term ‘affili-
ation period’ means a period which, under the terms 
of the health insurance coverage offered by the 
health maintenance organization, must expire before 
the health insurance coverage becomes effective.’’; 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
(D) by striking subsections (c), (d), (e), 
and (g); and 
(E) by redesignating subsection (f) (relat-
ing to special enrollment periods) as subsection 
(c). 
(2) GUARANTEED
AVAILABILITY
OF
GROUP 
HEALTH INSURANCE COVERAGE TO EMPLOYERS OF 
ALL SIZES IN THE GROUP MARKET.—Section 2711 
of such Act (42 U.S.C. 300gg–11) is amended— 
(A) in subsection (a)— 
(i) 
in 
the 
heading, 
by 
striking 
‘‘SMALL’’; 
(ii) in paragraph (1), by striking ‘‘(c) 
through (f)’’ and inserting ‘‘(b) through 
(d)’’; 
(iii) in paragraph (1), in the matter 
before subparagraph (A), by striking 
‘‘small’’; 
(iv) in paragraph (1)(A), by striking 
‘‘small employer (as defined in section 
2791(e)(4))’’ and inserting ‘‘employer’’; 
(v) in paragraph (2), by striking 
‘‘small’’ each place it appears; and 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
(vi) in paragraph (2), by striking 
‘‘coverage to a’’ and inserting ‘‘coverage to 
an’’; 
(B) by striking subsection (b); 
(C) in subsections (c), (d), and (e), by 
striking ‘‘small’’ each place it appears; and 
(D) by striking subsection (f). 
(3) APPLICATION
OF
UNIFORM
PREMIUMS.— 
Section 2711 of such Act, as so amended, is amend-
ed by inserting after subsection (a) the following 
new subsection: 
‘‘(b) APPLICATION OF UNIFORM PREMIUM.— 
‘‘(1) IN GENERAL.—Each and every health in-
surance issuer that offers health insurance coverage 
in the group market in a State shall— 
‘‘(A) shall charge the same premium price 
for the same coverage; and 
‘‘(B) shall openly disclose, in a manner 
specified by the Secretary and including disclo-
sure through the Internet, the amount of the 
premium price that is being charged for the 
coverage involved. 
‘‘(2) UNIFORM APPLICATION TO FAMILY COV-
ERAGE AND TO DIFFERENT GEOGRAPHIC AREAS.— 
Paragraph (1) shall be applied uniformly— 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
‘‘(A) for coverage on the basis of such dif-
ferent family categories as the Secretary ap-
proves; and 
‘‘(B) for coverage within each metropolitan 
statistical area and for coverage within the por-
tions of a State that are not within a metropoli-
tan statistical area. 
‘‘(3) APPLICATION.—Paragraph (1) shall not be 
construed as preventing variations in premiums that 
result from the application of a uniform monthly 
premium over different policy years.’’. 
(4) 
APPLICATION
OF
NONDISCRIMINATION 
RULES TO NONFEDERAL GOVERNMENTAL PLANS.— 
Section 2721(b)(2)(A) of such Act (42 U.S.C. 
300gg–21(b)(2)(A)) is amended by striking ‘‘sub-
parts 1 through 3’’ and ‘‘such subparts’’ and insert-
ing ‘‘subpart 2’’ and ‘‘such subpart’’, respectively. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply to plan years beginning on 
or after January 1, 2010, regardless of whether an 
individual is provided coverage under a group health 
plan before such date. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
health plan maintained pursuant to one or more col-
lective bargaining agreements between employee rep-
resentatives and one or more employers ratified be-
fore the date of the enactment of this Act, the 
amendments made by this section shall not apply to 
plan years beginning before the later of— 
(A) the date on which the last of the col-
lective bargaining agreements relating to the 
plan terminates (determined without regard to 
any extension thereof agreed to after the date 
of the enactment of this Act), or 
(B) January 1, 2011. 
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement under the 
amendments made by this section shall not be treat-
ed as a termination of such collective bargaining 
agreement. 
SEC. 3. NONDISCRIMINATION IN INDIVIDUAL HEALTH IN-
SURANCE. 
(a) IN GENERAL.—Section 2741 of the Public Health 
Service Act (42 U.S.C. 300gg–41) is amended— 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
a uniform monthly premium over different pol-
icy years. 
‘‘(b) ELIGIBLE INDIVIDUAL DEFINED.—In this part, 
the term ‘eligible individual’ means, with respect to an 
area, an individual who resides in such area, without re-
gard to the period of such residency, and who is— 
‘‘(1) a citizen or national of the United States; 
‘‘(2) an alien lawfully admitted to the United 
States for permanent residence; or 
‘‘(3) an alien who is otherwise lawfully residing 
in the United States.’’; 
(3) by striking subsection (c); 
(4) by redesignating subsection (d) and the first 
subsection (e) (relating to application of financial ca-
pacity limits) as subsections (c) and (d), respec-
tively; 
(5) in paragraph (1) of the subsection (e) relat-
ing to market requirements, by striking ‘‘or through 
one or more bona fide associations, or both’’; and 
(6) by striking subsection (f) and inserting the 
following: 
‘‘(f) UNIFORM RULES TO RESPOND TO ADVERSE SE-
LECTION.— 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS
‘‘(1) IN GENERAL.—The Secretary may estab-
lish rules for uniform application that are designed 
to deter individuals— 
‘‘(A) from enrolling in individual health in-
surance coverage only after they develop an ill-
ness or injury for which such coverage applies; 
and 
‘‘(B) from disenrolling from health insur-
ance coverage for periods in which they are un-
likely (or less likely) to require such coverage. 
‘‘(2) CONSIDERATIONS.—Such rules may take 
into account the financial and other circumstances 
of individuals for not being so enrolled or for so 
disenrolling.’’. 
(b) CONFORMING AMENDMENT.—Section 2742(b) of 
such Act (42 U.S.C. 300gg–42(b)) is amended by striking 
paragraph (5). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to health insurance 
coverage offered, sold, issued, renewed, in effect, or oper-
ated in the individual market after December 31, 2009. 
Æ 
VerDate Nov 24 2008 
20:33 Feb 14, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6301
E:\BILLS\H1092.IH
H1092
rwilkins on PROD1PC63 with BILLS