I
104TH CONGRESS
2D SESSION
H. R. 3030
To establish a minimum amount that may be applied as an aggregate lifetime
limit with respect to coverage under an employee health benefits plan
or a group health plan.
IN THE HOUSE OF REPRESENTATIVES
MARCH 6, 1996
Ms. ESHOO introduced the following bill; which was referred to the Committee
on Economic and Educational Opportunities, and in addition to the Com-
mittee on Commerce, 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 establish a minimum amount that may be applied as
an aggregate lifetime limit with respect to coverage under
an employee health benefits plan or a group health plan.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Christopher Reeve
Health Insurance Reform Act of 1996’’.
SEC. 2. LIMITATION ON LIFETIME AGGREGATE LIMITS FOR
GROUP HEALTH PLANS.
(a) IN GENERAL.—Except as provided in subsection
(b), an employee health benefit plan or a health plan is-
suer offering a group health plan may not impose an ag-
gregate dollar lifetime limit of less than $10,000,000 with
respect to coverage under the plan. The dollar amount
specified in the previous sentence shall be adjusted for in-
flation in fiscal years after the fiscal year in which this
section becomes effective.
(b) SMALL EMPLOYER EXCEPTION.—Subsection (a)
shall not apply to a group health plan offered to or main-
tained for employees of a single employer that employs 20
or fewer employees.
(c) RULE OF CONSTRUCTION.—Subsection (a) shall
not be construed as prohibiting the application by an em-
ployee health benefit plan or a health plan issuer offering
a group health plan of any limits, exclusions, or other
forms of cost containment mechanisms with respect to cov-
erage under the plan other than the aggregate limit per-
mitted under subsection (a).
(d) DISCLOSURE.—Any limits, exclusions, or other
cost containment mechanisms permitted under subsection
(c) shall be disclosed under section 3.
(e) APPLICATION OF SECTION.—This section shall
not apply to a health maintenance organization that meets
the requirements of title XIV of the Public Health Service
Act.
(f) EFFECTIVE DATE.—This section shall become ef-
fective with respect to health plans on the date that is
2 years after the date of the enactment of this Act.
SEC. 3. DISCLOSURE OF LIMITS AND EXCLUSIONS.
An employee health benefit plan or a health plan is-
suer offering a group health plan shall disclose, as part
of its solicitation and sales materials and in a form and
manner that is conspicuous and understandable to a rea-
sonable individual, any limits, exclusions, or cost contain-
ment mechanisms with respect to coverage provided under
the plan.
SEC. 4. INCORPORATION OF DEFINITIONS AND OTHER
TERMS.
For purposes of this Act—
(1) the definitions contained in section 2 of the
Health Insurance Reform Act of 1996 (H.R. 2893)
shall apply to this Act; and
(2) the provisions of title II and sections 303
and 304 of such Health Insurance Reform Act of
1996 (relating to enforcement, effective dates, and
severability) shall apply to the provisions of sections
2 and 3 of this Act in the same manner as if they
were parts of sections 103 and 105, respectively, of
such Act.
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