I
106TH CONGRESS
1ST SESSION
H. R. 2041
To amend title I of the Employee Retirement Income Security Act of 1974
to provide to participants and beneficiaries of group health plans access
to obstetric and gynecological care.
IN THE HOUSE OF REPRESENTATIVES
JUNE 8, 1999
Ms. GRANGER (for herself, Mrs. KELLY, Mrs. WILSON, and Ms. PRYCE of
Ohio) introduced the following bill; which was referred to the Committee
on Education and the Workforce
A BILL
To amend title I of the Employee Retirement Income Secu-
rity Act of 1974 to provide to participants and bene-
ficiaries of group health plans access to obstetric and
gynecological care.
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 ‘‘Patient Right to Ob-
stetric and Gynecological Care Act of 1999’’.
SEC. 2. PATIENT ACCESS TO OBSTETRIC AND GYNECO-
LOGICAL CARE.
(a) IN GENERAL.—Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security
Act of 1974 is amended by adding at the end the following
new section:
‘‘SEC. 714. PATIENT ACCESS TO OBSTETRIC AND GYNECO-
LOGICAL CARE
‘‘(a) IN GENERAL.—In any case in which a group
health plan (or a health insurance issuer offering health
insurance coverage in connection with the plan)—
‘‘(1) provides benefits under the terms of the
plan consisting of—
‘‘(A) routine gynecological care (such as
preventive women’s health examinations); or
‘‘(B) routine obstetric care (such as rou-
tine pregnancy-related services),
provided by a participating physician who specializes
in such care (or provides benefits consisting of pay-
ment for such care); and
‘‘(2) requires or provides for designation by a
participant or beneficiary of a participating primary
care provider,
if the primary care provider designated by such a partici-
pant or beneficiary is not such a physician, then the plan
(or issuer) shall meet the requirements of subsection (b).
‘‘(b) REQUIREMENTS.—A group health plan (or a
health insurance issuer offering health insurance coverage
in connection with the plan) meets the requirements of
this subsection, in connection with benefits described in
subsection (a) consisting of care described in subpara-
graph (A) or (B) of subsection (a)(1) (or consisting of
payment therefor), if the plan (or issuer)—
‘‘(1) does not require authorization or a referral
by the primary care provider in order to obtain such
benefits; and
‘‘(2) treats the ordering of other routine care of
the same type, by the participating physician pro-
viding the care described in subparagraph (A) or (B)
of subsection (a)(1), as the authorization of the pri-
mary care provider with respect to such care.
‘‘(c) CONSTRUCTION.—Nothing in subsection (b)(2)
shall waive any requirements of coverage relating to med-
ical necessity or appropriateness with respect to coverage
of gynecological or obstetric care so ordered.
‘‘(d) TREATMENT
OF MULTIPLE COVERAGE OP-
TIONS.—In the case of a plan providing benefits under two
or more coverage options, the requirements of this section
shall apply separately with respect to each coverage op-
tion.’’.
(b) CONFORMING AMENDMENT.—The table of con-
tents in section 1 of such Act is amended by adding at
the end of the items relating to subpart B of part 7 of
subtitle B of title I of such Act the following new item:
‘‘Sec. 714. Patient access to obstetric and gynecological care.’’.
SEC. 3. EFFECTIVE DATE AND RELATED RULES.
(a) IN GENERAL.—The amendments made by this
Act shall apply with respect to plan years beginning on
or after January 1 of the second calendar year following
the date of the enactment of this Act, except that the Sec-
retary of Labor may issue regulations before such date
under such amendments. The Secretary shall first issue
regulations necessary to carry out the amendments made
by this Act before the effective date thereof.
(b) LIMITATION ON ENFORCEMENT ACTIONS.—No
enforcement action shall be taken, pursuant to the amend-
ments made by this Act, against a group health plan or
health insurance issuer with respect to a violation of a re-
quirement imposed by such amendments before the date
of issuance of regulations issued in connection with such
requirement, if the plan or issuer has sought to comply
in good faith with such requirement.
(c) SPECIAL RULE FOR COLLECTIVE BARGAINING
AGREEMENTS.—In the case of a group health plan main-
tained pursuant to one or more collective bargaining
agreements between employee representatives and one or
more employers ratified before the date of the enactment
of this Act, the amendments made by this Act shall not
apply with respect to plan years beginning before the later
of—
(1) the date on which the last of the collective
bargaining agreements relating to the plan termi-
nates (determined without regard to any extension
thereof agreed to after the date of the enactment of
this Act); or
(2) January 1, 2002.
For purposes of this subsection, any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by this Act shall not be treated
as a termination of such collective bargaining agreement.
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