individual’s physician, that a health status 
factor makes it unreasonably difficult or 
medically inadvisable for the individual to 
satisfy or attempt to satisfy the otherwise 
applicable standard. 
‘‘(E) The plan or issuer involved shall dis-
close in all plan materials describing the terms 
of the wellness program the availability of a 
reasonable alternative standard (or the possi-
bility of waiver of the otherwise applicable 
standard) required under subparagraph (D). If 
plan materials disclose that such a program is 
available, without describing its terms, the dis-
closure under this subparagraph shall not be re-
quired. 
‘‘SEC. 199. PROHIBITION OF PREEXISTING CONDITION EX-
CLUSIONS 
OR 
OTHER 
DISCRIMINATION 
BASED ON HEALTH STATUS. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage may not impose any preexisting condition 
exclusion with respect to such plan or coverage. 
‘‘(b) DEFINITIONS.—For purposes of this section— 
‘‘(1) PREEXISTING CONDITION EXCLUSION.— 
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‘‘(A) IN GENERAL.—The term ‘preexisting 
condition exclusion’ means, with respect to cov-
erage, a limitation or exclusion of benefits relat-
ing to a condition based on the fact that the 
condition was present before the date of enroll-
ment for such coverage, whether or not any 
medical advice, diagnosis, care, or treatment 
was recommended or received before such date. 
‘‘(B) TREATMENT OF GENETIC INFORMA-
TION.—Genetic information shall not be treated 
as a condition described in subsection (a)(1) in 
the absence of a diagnosis of the condition re-
lated to such information. 
‘‘(2) ENROLLMENT
DATE.—The term ‘enroll-
ment date’ means, with respect to an individual cov-
ered under a group health plan or health insurance 
coverage, the date of enrollment of the individual in 
the plan or coverage or, if earlier, the first day of 
the waiting period for such enrollment. 
‘‘(3) LATE
ENROLLEE.—The term ‘late en-
rollee’ means, with respect to coverage under a 
group health plan, a participant or beneficiary who 
enrolls under the plan other than during— 
‘‘(A) the first period in which the indi-
vidual is eligible to enroll under the plan; or 
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‘‘(B) a special enrollment period under 
subsection (f). 
‘‘(4) WAITING PERIOD.—The term ‘waiting pe-
riod’ means, with respect to a group health plan and 
an individual who is a potential participant or bene-
ficiary in the plan, the period that must pass with 
respect to the individual before the individual is eli-
gible to be covered for benefits under the terms of 
the plan. 
‘‘(c) RULES RELATING
TO CREDITING PREVIOUS 
COVERAGE.— 
‘‘(1) CREDITABLE
COVERAGE
DEFINED.—For 
purposes of this title, the term ‘creditable coverage’ 
means, with respect to an individual, coverage of the 
individual under any of the following: 
‘‘(A) A group health plan. 
‘‘(B) Health insurance coverage. 
‘‘(C) Part A or part B of title XVIII of the 
Social Security Act. 
‘‘(D) Title XIX of the Social Security Act, 
other than coverage consisting solely of benefits 
under section 1928. 
‘‘(E) Chapter 55 of title 10, United States 
Code. 
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‘‘(F) A medical care program of the Indian 
Health Service or of a tribal organization. 
‘‘(G) A State health benefits risk pool. 
‘‘(H) A health plan offered under chapter 
89 of title 5, United States Code. 
‘‘(I) A public health plan (as defined in 
regulations). 
‘‘(J) A health benefit plan under section 
5(e) of the Peace Corps Act (22 U.S.C. 
2504(e)). 
Such term does not include coverage consisting sole-
ly of coverage of excepted benefits (as defined in sec-
tion 2791(c)). 
‘‘(2) NOT COUNTING PERIODS BEFORE SIGNIFI-
CANT BREAKS IN COVERAGE.— 
‘‘(A) IN GENERAL.—A period of creditable 
coverage shall not be counted, with respect to 
enrollment of an individual under a group or in-
dividual health plan, if, after such period and 
before the enrollment date, there was a 63-day 
period during all of which the individual was 
not covered under any creditable coverage. 
‘‘(B) WAITING PERIOD NOT TREATED AS A 
BREAK IN COVERAGE.—For purposes of sub-
paragraph (A) and subsection (d)(4), any pe-
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riod that an individual is in a waiting period for 
any coverage under a group or individual health 
plan (or for group health insurance coverage) or 
is in an affiliation period (as defined in sub-
section (g)(2)) shall not be taken into account 
in determining the continuous period under 
subparagraph (A). 
‘‘(C) TAA-ELIGIBLE INDIVIDUALS.—In the 
case of plan years beginning before January 1, 
2014— 
‘‘(i) TAA PRE-CERTIFICATION PERIOD 
RULE.—In the case of a TAA-eligible indi-
vidual, the period beginning on the date 
the individual has a TAA-related loss of 
coverage and ending on the date that is 7 
days after the date of the issuance by the 
Secretary (or by any person or entity des-
ignated by the Secretary) of a qualified 
health insurance costs credit eligibility cer-
tificate for such individual for purposes of 
section 7527 of the Internal Revenue Code 
of 1986 shall not be taken into account in 
determining the continuous period under 
subparagraph (A). 
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‘‘(ii) DEFINITIONS.—The terms ‘TAA- 
eligible individual’ and ‘TAA-related loss of 
coverage’ have the meanings given such 
terms in section 2205(b)(4). 
‘‘(3) METHOD OF CREDITING COVERAGE.— 
‘‘(A) STANDARD METHOD.—Except as oth-
erwise provided under subparagraph (B), for 
purposes of applying subsection (a)(3), a group 
health plan, and a health insurance issuer offer-
ing group or individual health insurance cov-
erage, shall count a period of creditable cov-
erage without regard to the specific benefits 
covered during the period. 
‘‘(B) ELECTION OF ALTERNATIVE METH-
OD.—A group health plan, or a health insur-
ance issuer offering group or individual health 
insurance, may elect to apply subsection (a)(3) 
based on coverage of benefits within each of 
several classes or categories of benefits specified 
in regulations rather than as provided under 
subparagraph (A). Such election shall be made 
on a uniform basis for all participants and 
beneficiaries. Under such election a group or in-
dividual health plan or issuer shall count a pe-
riod of creditable coverage with respect to any 
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‘‘(4) ESTABLISHMENT OF PERIOD.—Periods of 
creditable coverage with respect to an individual 
shall be established through presentation of certifi-
cations described in subsection (e) or in such other 
manner as may be specified in regulations. 
‘‘(d) EXCEPTIONS.— 
‘‘(1) EXCLUSION NOT APPLICABLE TO CERTAIN 
NEWBORNS.—Subject to paragraph (4), a group 
health plan, and a health insurance issuer offering 
group or individual health insurance coverage, may 
not impose any preexisting condition exclusion in the 
case of an individual who, as of the last day of the 
30-day period beginning with the date of birth, is 
covered under creditable coverage. 
‘‘(2) EXCLUSION NOT APPLICABLE TO CERTAIN 
ADOPTED CHILDREN.—Subject to paragraph (4), a 
group health plan, and a health insurance issuer of-
fering group or individual health insurance coverage, 
may not impose any preexisting condition exclusion 
in the case of a child who is adopted or placed for 
adoption before attaining 18 years of age and who, 
as of the last day of the 30-day period beginning on 
the date of the adoption or placement for adoption, 
is covered under creditable coverage. The previous 
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sentence shall not apply to coverage before the date 
of such adoption or placement for adoption. 
‘‘(3) EXCLUSION NOT APPLICABLE TO PREG-
NANCY.—A group health plan, and health insurance 
issuer offering group or individual health insurance 
coverage, may not impose any preexisting condition 
exclusion relating to pregnancy as a preexisting con-
dition. 
‘‘(4) LOSS
IF
BREAK
IN
COVERAGE.—Para-
graphs (1) and (2) shall no longer apply to an indi-
vidual after the end of the first 63-day period during 
all of which the individual was not covered under 
any creditable coverage. 
‘‘(e) CERTIFICATIONS
AND DISCLOSURE
OF COV-
ERAGE.— 
‘‘(1) REQUIREMENT
FOR
CERTIFICATION
OF 
PERIOD OF CREDITABLE COVERAGE.— 
‘‘(A) IN GENERAL.—A group health plan, 
and a health insurance issuer offering group or 
individual health insurance coverage, shall pro-
vide the certification described in subparagraph 
(B)— 
‘‘(i) at the time an individual ceases 
to be covered under the plan or otherwise 
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becomes covered under a COBRA continu-
ation provision; 
‘‘(ii) in the case of an individual be-
coming covered under such a provision, at 
the time the individual ceases to be covered 
under such provision; and 
‘‘(iii) on the request on behalf of an 
individual made not later than 24 months 
after the date of cessation of the coverage 
described in clause (i) or (ii), whichever is 
later. 
The certification under clause (i) may be pro-
vided, to the extent practicable, at a time con-
sistent with notices required under any applica-
ble COBRA continuation provision. 
‘‘(B) CERTIFICATION.—The certification 
described in this subparagraph is a written cer-
tification of— 
‘‘(i) the period of creditable coverage 
of the individual under such plan and the 
coverage (if any) under such COBRA con-
tinuation provision; and 
‘‘(ii) the waiting period (if any) (and 
affiliation period, if applicable) imposed 
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with respect to the individual for any cov-
erage under such plan. 
‘‘(C) ISSUER COMPLIANCE.—To the extent 
that medical care under a group health plan 
consists of group health insurance coverage, the 
plan is deemed to have satisfied the certification 
requirement under this paragraph if the health 
insurance issuer offering the coverage provides 
for such certification in accordance with this 
paragraph. 
‘‘(2) DISCLOSURE OF INFORMATION ON PRE-
VIOUS BENEFITS.—In the case of an election de-
scribed in subsection (c)(3)(B) by a group health 
plan or health insurance issuer, if the plan or issuer 
enrolls an individual for coverage under the plan and 
the individual provides a certification of coverage of 
the individual under paragraph (1)— 
‘‘(A) upon request of such plan or issuer, 
the entity which issued the certification pro-
vided by the individual shall promptly disclose 
to such requesting plan or issuer information 
on coverage of classes and categories of health 
benefits available under such entity’s plan or 
coverage; and 
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‘‘(B) such entity may charge the request-
ing plan or issuer for the reasonable cost of dis-
closing such information. 
‘‘(3) REGULATIONS.—The Secretary shall es-
tablish rules to prevent an entity’s failure to provide 
information under paragraph (1) or (2) with respect 
to previous coverage of an individual from adversely 
affecting any subsequent coverage of the individual 
under another group health plan or health insurance 
coverage. 
‘‘(f) SPECIAL ENROLLMENT PERIODS.— 
‘‘(1) INDIVIDUALS LOSING OTHER COVERAGE.— 
A group health plan, and a health insurance issuer 
offering group health insurance coverage in connec-
tion with a group health plan, shall permit an em-
ployee who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of such 
an employee if the dependent is eligible, but not en-
rolled, for coverage under such terms) to enroll for 
coverage under the terms of the plan if each of the 
following conditions is met: 
‘‘(A) The employee or dependent was cov-
ered under a group health plan or had health 
insurance coverage at the time coverage was 
previously offered to the employee or dependent. 
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‘‘(B) The employee stated in writing at 
such time that coverage under a group health 
plan or health insurance coverage was the rea-
son for declining enrollment, but only if the 
plan sponsor or issuer (if applicable) required 
such a statement at such time and provided the 
employee with notice of such requirement (and 
the consequences of such requirement) at such 
time. 
‘‘(C) The employee’s or dependent’s cov-
erage described in subparagraph (A)— 
‘‘(i) was under a COBRA continu-
ation provision and the coverage under 
such provision was exhausted; or 
‘‘(ii) was not under such a provision 
and either the coverage was terminated as 
a result of loss of eligibility for the cov-
erage (including as a result of legal separa-
tion, divorce, death, termination of employ-
ment, or reduction in the number of hours 
of employment) or employer contributions 
toward such coverage were terminated. 
‘‘(D) Under the terms of the plan, the em-
ployee requests such enrollment not later than 
30 days after the date of exhaustion of coverage 
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described in subparagraph (C)(i) or termination 
of coverage or employer contribution described 
in subparagraph (C)(ii). 
‘‘(2) FOR DEPENDENT BENEFICIARIES.— 
‘‘(A) IN GENERAL.—If— 
‘‘(i) a group health plan makes cov-
erage available with respect to a dependent 
of an individual; 
‘‘(ii) the individual is a participant 
under the plan (or has met any waiting pe-
riod applicable to becoming a participant 
under the plan and is eligible to be enrolled 
under the plan but for a failure to enroll 
during a previous enrollment period); and 
‘‘(iii) a person becomes such a de-
pendent of the individual through mar-
riage, birth, or adoption or placement for 
adoption, 
the group health plan shall provide for a de-
pendent special enrollment period described in 
subparagraph (B) during which the person (or, 
if not otherwise enrolled, the individual) may be 
enrolled under the plan as a dependent of the 
individual, and in the case of the birth or adop-
tion of a child, the spouse of the individual may 
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be enrolled as a dependent of the individual if 
such spouse is otherwise eligible for coverage. 
‘‘(B) DEPENDENT SPECIAL ENROLLMENT 
PERIOD.—A dependent special enrollment pe-
riod under this subparagraph shall be a period 
of not less than 30 days and shall begin on the 
later of— 
‘‘(i) the date dependent coverage is 
made available; or 
‘‘(ii) the date of the marriage, birth, 
or adoption or placement for adoption (as 
the case may be) described in subpara-
graph (A)(iii). 
‘‘(C) NO
WAITING
PERIOD.—If an indi-
vidual seeks to enroll a dependent during the 
first 30 days of such a dependent special enroll-
ment period, the coverage of the dependent 
shall become effective— 
‘‘(i) in the case of marriage, not later 
than the first day of the first month begin-
ning after the date the completed request 
for enrollment is received; 
‘‘(ii) in the case of a dependent’s 
birth, as of the date of such birth; or 
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‘‘(iii) in the case of a dependent’s 
adoption or placement for adoption, the 
date of such adoption or placement for 
adoption. 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE 
OF MEDICAID AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, 
and a health insurance issuer offering group 
health insurance coverage in connection with a 
group health plan, shall permit an employee 
who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of 
such an employee if the dependent is eligible, 
but not enrolled, for coverage under such 
terms) to enroll for coverage under the terms of 
the plan if either of the following conditions is 
met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
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bility for such coverage and the employee 
requests coverage under the group health 
plan (or health insurance coverage) not 
later than 60 days after the date of termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, under such Medicaid 
plan or State child health plan (including 
under any waiver or demonstration project 
conducted under or in relation to such a 
plan), if the employee requests coverage 
under the group health plan or health in-
surance coverage not later than 60 days 
after the date the employee or dependent is 
determined to be eligible for such assist-
ance. 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
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‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
compliance with this subclause, the 
employer may use any State-specific 
model notice developed in accordance 
with section 701(f)(3)(B)(i)(II) of the 
Employee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
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‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section 
104(b) of the Employee Retirement 
Income Security Act of 1974. 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID
AND
CHIP
ELIGIBLE
INDIVID-
UALS.—In the case of an enrollee in a 
group health plan who is covered under a 
Medicaid plan of a State under title XIX 
of the Social Security Act or under a State 
child health plan under title XXI of such 
Act, the plan administrator of the group 
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health plan shall disclose to the State, 
upon request, information about the bene-
fits available under the group health plan 
in sufficient specificity, as determined 
under regulations of the Secretary of 
Health and Human Services in consulta-
tion with the Secretary that require use of 
the model coverage coordination disclosure 
form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Reau-
thorization Act of 2009, so as to permit 
the State to make a determination (under 
paragraph (2)(B), (3), or (10) of section 
2105(c) of the Social Security Act or oth-
erwise) concerning the cost-effectiveness of 
the State providing medical or child health 
assistance through premium assistance for 
the purchase of coverage under such group 
health plan and in order for the State to 
provide supplemental benefits required 
under paragraph (10)(E) of such section 
or other authority. 
‘‘(g) USE OF AFFILIATION PERIOD BY HMOS AS AL-
TERNATIVE TO PREEXISTING CONDITION EXCLUSION.— 
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