the period not more than 3 months before the date
of enrollment for such coverage or under such plan.
‘‘(2) LIMITATION ON EXCLUSION PERIOD.—
‘‘(A) GENERAL RULE OF MAXIMUM OF 6-
MONTH EXCLUSION.—Subject to paragraph (3),
the limitation or exclusion extends for a period
not more than 6 months (or 12 months in the
case of a late enrollee described in subpara-
graph (B)) after such date of enrollment.
‘‘(B) LATE ENROLLEE DESCRIBED.—
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), a late enrollee de-
scribed in this subparagraph with respect
to a group health plan is an individual who
becomes covered under the plan but who,
at the time the individual first was eligible
to elect such coverage, had elected not to
be covered under the plan.
‘‘(ii) EXCEPTION
FOR
INDIVIDUALS
WITH
CONTINUOUS
COVERAGE.—An indi-
vidual shall not be considered to be a late
enrollee with respect to a plan if the indi-
vidual establishes that, with respect to the
period beginning on the date the individual
first could have obtained coverage under
the plan and until the date the individual
was so covered, there was no period of
more than 2 months during all of which
the individual neither had health insurance
coverage (including coverage described in
subparagraph (C) or (D) of section
4991(2)) or was covered under any group
health plan.
‘‘(3) CREDIT FOR PREVIOUS QUALIFYING COV-
ERAGE.—In the case of an individual who is in a pe-
riod of qualifying previous coverage (as defined in
section 4987(b)(3)) as of the date of enrollment for
health insurance coverage or under the group health
plan, the limitation or exclusion period under para-
graph (2)(A) shall be reduced by the length of such
period of qualifying previous coverage.
‘‘(4) EXCEPTION
FOR
TREATMENT
OF
PREG-
NANCY.—The limitation or exclusion does not apply
to treatment relating to pregnancy.
‘‘(5) EXCEPTION
FOR
CERTAIN
DEPENDENT
COVERAGE.—
‘‘(A) NEWBORNS.—The limitation or exclu-
sion does not apply to a child who has health
insurance coverage (or is covered under a group
health plan) as a dependent within 1 month of
the birthdate until such time as the child does
not have such coverage (or is not so covered)
for a continuous period of more than 2 months.
‘‘(B) ADOPTED
CHILDREN.—The limita-
tion or exclusion does not apply (beginning on
the date of adoption) to an adopted child who
has health insurance coverage (or is covered
under a group health plan) within 1 month of
such date until such time as the child does not
have such coverage (or is not so covered) for a
continuous period of more than 2 months.
‘‘(6) VOLUNTARY WAIVER.—The look-back pe-
riod described in paragraph (1) and the maximum
period of exclusion under paragraph (2)(A) may ex-
tend over a longer period than the period specified
in the respective subsection if the individual involved
waives the protection provided under such para-
graph.
‘‘(b) LIMITATION ON USE OF DELAYED COVERAGE
IN LIEU OF PREEXISTING EXCLUSION LIMITATIONS.—
‘‘(1) IN GENERAL.—A carrier offering health
insurance coverage and a group health plan provid-
ing coverage, with respect to an individual, may
delay the effective date of coverage of the individual
beyond the first date of the month beginning after
the date of election of the coverage only if the fol-
lowing requirements are met:
‘‘(A) LIMITATION
ON
DELAY
PERIOD.—
Subject to paragraph (2), such additional delay
does not extend over a period of longer than 2
months (or 3 months in the case of a late en-
rollee described in subsection (a)(2)(B)).
‘‘(B) NO
SUBSEQUENT
APPLICATION
OF
ANY PREEXISTING EXCLUSION.—After the pe-
riod of such additional delay, no limitation or
exclusion described in subsection (a) may be ap-
plied.
‘‘(C) NO PREMIUMS.—No premium or re-
quired contribution may be charged for the pe-
riod before the effective date of coverage.
Nothing in this paragraph shall waive the applicable
requirements of subsection (a).
‘‘(2) VOLUNTARY
WAIVER.—The additional
delay may extend over a period longer than the pe-
riod specified under paragraph (1)(A) if the individ-
ual involved waives the protection provided under
such paragraph.
‘‘(c) PREEXISTING CONDITION DEFINED.—
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘preexisting condition’ means, with re-
spect to coverage under health insurance coverage or
under a group health plan, a condition which was di-
agnosed or treated, or a condition for which a rea-
sonably prudent person would have sought medical
care diagnosis or treatment, within the 3-month pe-
riod ending on the day before the date of enrollment
(without regard to any delayed coverage period).
‘‘(2) TREATMENT OF INFORMATION RELATING
TO GENETIC PREDISPOSITION.—For purposes of this
section, information relating to one’s genetic pre-
disposition alone shall not be considered to be a pre-
existing condition, so long as treatment of the condi-
tion to which the predisposition is applicable has not
been (or should not have been) sought during the 3-
month period described in paragraph (1).
‘‘SEC. 4989. GUARANTEED RENEWABILITY OF HEALTH IN-
SURANCE COVERAGE.
‘‘(a) IN GENERAL.—Except as provided in subsection
(b), a carrier offering health insurance coverage shall
guarantee that such coverage may be renewed or contin-
ued in force at the option of the policyholder or contract-
holder.
‘‘(b) GROUNDS FOR REFUSAL TO RENEW.—
‘‘(1) IN GENERAL.—Subject to paragraphs (3)
and (4), a carrier offering health insurance coverage
may cancel or refuse to renew such coverage—
‘‘(A) for nonpayment of premium or con-
tribution in accordance with the terms of the
coverage;
‘‘(B) for fraud or misrepresentation of ma-
terial fact;
‘‘(C) because of a general discontinuation
or termination of that type of coverage, but
only if the conditions described in clause (i) or
(ii) of paragraph (2)(A) are met;
‘‘(D) in the case of coverage offered in
connection with a group health plan, for failure
of the plan to maintain participation rules con-
sistent with paragraph (4); or
‘‘(E) in the case of coverage that is con-
tinuation coverage under section 4980B, for
loss of eligibility to continue such coverage.
‘‘(2) CONDITIONS FOR DISCONTINUATION.—
‘‘(A) IN GENERAL.—
‘‘(i) 
NONDISCRIMINATORY
SUBSTI-
TUTION
OF
ALTERNATIVE
COVERAGE.—
The conditions described in this clause are
the following:
‘‘(I) The carrier provides notice
to each group purchaser covered
under the type of health insurance
coverage involved (and participants
and beneficiaries covered under such
coverage offered in connection with a
group health plan) of the discontinu-
ation of coverage at least 90 days
prior to the date of such discontinu-
ation.
‘‘(II) The carrier is no longer of-
fering health insurance coverage of
the type involved to new policyholders
or contractholders.
‘‘(III) The carrier is offering to
the previously covered policyholder or
contractholder the option to purchase
any other type of health insurance
coverage currently being offered to
new policyholders or contractholders.
‘‘(IV) The discontinuation or ter-
mination of coverage and option to re-
place with other coverage is made uni-
formly without regard to the health
status or insurability of any person
provided health insurance coverage.
‘‘(ii) GENERAL DISCONTINUATION OF
COVERAGE
IN
A
STATE.—The conditions
described in this clause are as follows:
‘‘(I) The carrier is discontinuing
and not renewing all types of health
insurance coverage within a class of
coverage (as defined in subparagraph
(B)) in a State.
‘‘(II) The carrier provides notice
to each purchaser within the class of
coverage involved (and participants
and beneficiaries covered under such
coverage offered in connection with a
group health plan) of the discontinu-
ation of coverage at least 180 days
prior to the date of such discontinu-
ation.
‘‘(B) CLASSES
OF
COVERAGE.—For pur-
poses of subparagraph (A)(ii), each of the fol-
lowing is considered a separate class of health
insurance coverage:
‘‘(i) INDIVIDUAL COVERAGE.—Health
insurance coverage not offered in connec-
tion with any group health plan.
‘‘(ii) SMALL EMPLOYER GROUP COV-
ERAGE.—Health insurance coverage of-
fered to small employers (as defined by
State law) in connection with any group
health plan for covered employees and
their dependents.
‘‘(iii) OTHER
GROUP
COVERAGE.—
Health insurance coverage offered in con-
nection with a group health plan and not
described in clause (ii).
‘‘(C) 
PROHIBITION
ON
MARKET
RE-
ENTRY.—In the case of a discontinuation of a
type or class coverage in a State under this
paragraph, the carrier may not provide for the
issuance of any health insurance coverage with-
in the type or class of coverage discontinued in
the State involved during the 5-year period be-
ginning on the date of the discontinuation of
the last coverage not so renewed.
‘‘(3) APPLICATION
OF
GEOGRAPHIC
LIMITA-
TIONS TO COVERAGE PROVIDED THROUGH A NET-
WORK ARRANGEMENT.—
‘‘(A) IN GENERAL.—Coverage under health
insurance coverage or under a group health
plan that consists primarily of coverage through
a network arrangement (as defined in subpara-
graph (B)) may be denied to individuals who
neither live nor reside in the service area of the
arrangement, but only if such denial is applied
uniformly, without regard to the health status
or the insurability of particular individuals.
‘‘(B) 
NETWORK
ARRANGEMENTS.—For
purposes of subparagraph (A), the term ‘net-
work arrangement’ means, with respect to a
group health plan or under health insurance
coverage, an arrangement under such plan or
coverage whereby providers agree to provide
items and services covered under the arrange-
ment to individuals covered under the plan or
who have such coverage.
‘‘(4) 
MINIMUM
PARTICIPATION
REQUIRE-
MENTS.—A carrier that offers health insurance cov-
erage in connection with a group health plan that
covers the employees of one or more employers may
require to provide that a minimum percentage of eli-
gible employees of such an employer obtain such cov-
erage if such percentage is applied uniformly to all
such coverage offered to employers of comparable
size.
‘‘SEC. 4990. RELATION TO STATE STANDARDS.
‘‘(a) IN GENERAL.—Nothing in this chapter shall
prevent a State from establishing, implementing, or con-
tinuing in effect standards related to health insurance cov-
erage (including the issuance, renewal, or rating of such
coverage) if such standards are at least as stringent as
the standards established under this chapter with respect
to such coverage.
‘‘(b) CONSTRUCTION.—Nothing in this chapter shall
be construed to preempt State laws that—
‘‘(1) require carriers to impose a shorter look-
back 
period 
than 
that 
specified 
in 
section
4988(a)(1),
‘‘(2) require carriers to impose a limitation or
exclusion of benefits relating to the treatment of a
preexisting condition for periods that are shorter
than those provided for under section 4988(a)(2)(A),
or
‘‘(3) allow individuals to be considered to be in
a period of qualifying previous coverage if such indi-
vidual experiences a lapse in coverage that is greater
than 
the 
period 
specified 
in 
section
4988(a)(2)(B)(ii);
unless such laws are preempted by section 514 of the Em-
ployee Retirement Income Security Act of 1974 (29
U.S.C. 1144).
‘‘SEC. 4991. DEFINITIONS.
‘‘For purposes of this chapter—
‘‘(1) CARRIER.—The term ‘carrier’ means—
‘‘(A) a licensed insurance company;
‘‘(B) an entity offering prepaid hospital or
medical service plan;
‘‘(C) a health maintenance organization;
and
‘‘(D) any similar entity which (i) is en-
gaged in the business of providing a plan of
health insurance or health benefits or services
and (ii) is regulated under State law for sol-
vency.
‘‘(2) HEALTH INSURANCE COVERAGE.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), the term ‘health insurance
coverage’ means any hospital or medical service
policy or certificate, hospital or medical service
plan contract, or health maintenance organiza-
tion group contract offered by a carrier.
‘‘(B) EXCEPTION.—Such term does not in-
clude any of the following (or any combination
of the following):
‘‘(i) Coverage only for accident, den-
tal, vision, or disability income, or any
combination thereof.
‘‘(ii) Medicare supplemental health in-
surance.
‘‘(iii) Coverage issued as a supplement
to liability insurance.
‘‘(iv) Liability insurance, including
general liability insurance and automobile
liability insurance.
‘‘(v) Workers’ compensation or similar
insurance.
‘‘(vi) Automobile medical-payment in-
surance.
‘‘(vii) Coverage providing wages or
payments in lieu of wages for any period
during which an employee is absent from
work on account of sickness or injury.
‘‘(viii) A long-term care insurance cov-
erage, including a nursing home fixed in-
demnity policy (unless the Secretary of
Health and Human Services, in consulta-
tion with the Secretaries of Labor and of
the Treasury, determines that such cov-
erage is sufficiently comprehensive so that
it should be treated as health insurance
coverage.
‘‘(ix) Any coverage not described in
any preceding clause which consists of ben-
efit payments, on a periodic basis, for a
specified disease or illness or period of hos-
pitalization without regard to the costs in-
curred or services rendered during the pe-
riod to which the payments relate.
‘‘(x) Such other coverage as the Sec-
retary of Health and Human Services, in
consultation with the Secretaries of Labor
and of the Treasury, determines is not
health insurance coverage.
‘‘(C) 
TREATMENT
OF
STATE
RISK
POOLS.—Except 
for 
purposes 
of 
sections
4987(b)(3), 4988(a)(2)(B)(ii), and 4988(a)(3),
such term does not include coverage provided
through a State risk pool, uncompensated care
pool or similar subsidized program.
‘‘(D) PUBLIC PLANS COUNTED FOR PUR-
POSES OF QUALIFYING PREVIOUS COVERAGE.—
For 
purposes 
of 
sections 
4987(b)(3),
4988(a)(2)(B)(ii), and 4988(a)(3), such term
also includes coverage under any of the follow-
ing:
‘‘(i) The medicare program under title
XVIII of the Social Security Act.
‘‘(ii) A State plan under title XIX of
such Act.
‘‘(iii) A program of the Indian Health
Service.
‘‘(iv) The Civilian Health and Medical
Program 
of 
the 
Uniformed 
Services
(CHAMPUS) under title 10, United States
Code.
‘‘(v) Any other similar governmental
health insurance program (including a pro-
gram described in subparagraph (C)).
‘‘(3) GROUP HEALTH PLAN.—The term ‘group
health plan’ has the meaning given such term in sec-
tion 5000(b)(1), but does not include any type of
coverage excluded from the definition of health in-
surance coverage under paragraph (2)(B) or (C) and
does not include any plan unless at least one of the
following requirements is met:
‘‘(A) Any portion of the premium or bene-
fits under the plan is paid by or on behalf of
the employer.
‘‘(B) An eligible employee or dependent is
reimbursed, whether through wage adjustments
or otherwise, by or on behalf of the employer
for any portion of the premium.
‘‘(C) The health benefit plan is treated by
the employer, or any of the eligible employees
or dependents, as part of a plan or program for
the purposes of section 162, section 25, or sec-
tion 106 of the Internal Revenue Code of 1986.
‘‘(4) STATE.—The term ‘State’ includes the
District of Columbia, Puerto Rico, the Virgin Is-
lands, Guam, American Samoa, and the Northern
Mariana Islands.’’
(b) EFFECTIVE DATE.—
(1) IN GENERAL.—The amendments made by
subsection (a) shall apply to individuals who com-
mence health insurance coverage or coverage under
a group health plan after the first day of the first
month beginning more than 6 months after the date
of the enactment of this Act.