114
any health benefit plan that is not an insured health
benefit plan.’’
(b) NONDEDUCTIBILITY OF TAX.—Subsection (a) of
section 275 of such Code (relating to nondeductibility of
certain taxes) is amended by adding at the end thereof
the following new paragraph:
‘‘(7) Taxes imposed by section 5000A (failure
to satisfy certain standards for health insurance).’’
(c) CLERICAL AMENDMENTS.—
(1) So much of chapter 47 of such Code as pre-
cedes subsection (a) of section 5000 is amended to
read as follows:
‘‘CHAPTER 47—TAXES RELATING TO
HEALTH BENEFIT PLANS
‘‘Sec. 5000. Contributions to nonconforming large group health
plans.
‘‘Sec. 5000A. Failure to satisfy certain standards for health insur-
ance.
‘‘SEC. 5000. CONTRIBUTIONS TO NONCONFORMING LARGE
GROUP HEALTH PLANS.’’
(2) The table of chapters for subtitle D of such
Code is amended by striking the item relating to
chapter 47 and inserting the following new item:
‘‘Chapter 47. Taxes relating to health benefit plans.’’
SEC. 302. HEALTH BENEFIT PLAN STANDARDS.
The Social Security Act is amended by adding at the
end the following new title:
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‘‘TITLE XXI—HEALTH BENEFIT PLAN
STANDARDS
‘‘SEC. 2101. STANDARDS AND REQUIREMENTS FOR HEALTH
BENEFIT PLANS.
‘‘(a) CERTIFICATION REQUIRED.—
‘‘(1) IN GENERAL.—No health benefit plan (as
defined in section 2108(3)) may be issued on or
after the effective date specified in subsection (d)
(and no new contract may be offered under such
plan with respect to any individual or group begin-
ning on or after such effective date) unless the plan
has been certified—
‘‘(A) by the Secretary (in accordance with
such procedures as the Secretary establishes),
or
‘‘(B) by a State regulatory program (ap-
proved under subsection (b)),
as meeting the standards established under section
2102 by such effective date.
‘‘(2) PLAN
DISAPPROVED.—If the Secretary
(or, in the case of a plan certified by a State regu-
latory program, the State) determines that a health
benefit plan does not meet the applicable standards
of this title on or after such effective date, no cov-
erage may be provided under the plan to individuals
116
not enrolled as of the date of the determination and
the plan may not be continued for plan years begin-
ning after the date of such determination until the
Secretary (or program) determines that such plan is
in compliance with such standards.
‘‘(b) STATE APPROVED PROGRAMS.—
‘‘(1) IN GENERAL.—If the Secretary determines
that a State has in effect an effective regulatory pro-
gram for the application of the standards established
under section 2102 to health benefit plans, the Sec-
retary may approve such program for purposes of
certification of health benefit plans under this title.
‘‘(2) ANNUAL REPORTS.—As a condition for the
continued approval of such a regulatory program,
the State shall report to the Secretary annually such
information as the Secretary may require with re-
spect to the performance of the program. Such infor-
mation shall include a list of the health benefit plans
certified under the program, the compliance of such
plans with the standards established under section
2102, and enforcement actions taken to ensure such
compliance.
‘‘(3) PERIODIC SECRETARIAL REVIEW OF STATE
REGULATORY
PROGRAMS.—The Secretary annually
shall review State regulatory programs approved
117
under paragraph (1) to determine if they continue to
apply and enforce the standards. If the Secretary
initially determines that a State regulatory program
no longer is applying and enforcing such standards,
the Secretary shall provide the State an opportunity
to adopt such a plan of correction that would bring
such program into compliance. If the Secretary
makes a final determination that the State regu-
latory program, fails to apply and enforce such
standards after such an opportunity, the Secretary
shall disapprove such program and reassume respon-
sibility for certification of all health benefit plans in
that State.
‘‘(4) GAO AUDITS.—The Comptroller General
shall conduct periodic reviews on a sample of State
regulatory programs approved under paragraph (1)
to determine their compliance with the requirements
of such paragraph. The Comptroller General shall
report to the Secretary and Congress on the findings
of such reviews.
‘‘(c) EXCISE TAX SANCTIONS.—For application of
excise tax in the case of a nonqualified health benefit plan,
see section 5000A of the Internal Revenue Code of 1986.
‘‘(d) EFFECTIVE DATE.—The effective date specified
in this subsection is January 1, 1994.
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‘‘SEC. 2102. ESTABLISHMENT OF STANDARDS.
‘‘(a) ESTABLISHMENT
OF STANDARDS.—The Sec-
retary shall develop and publish, by not later than October
1, 1993, specific standards to implement the requirements
of this title and to be applied under section 5000A of the
Internal Revenue Code of 1986.
‘‘(b) MORE STRINGENT STATE STANDARDS PER-
MITTED.—In the case of insured health benefit plans, a
State may implement standards that are more stringent
than the standards established under this section.
‘‘(c) APPLICATION TO ERISA.—The Secretary shall
consult with the Secretary of Labor concerning the appli-
cation of the requirements of this title to employee welfare
benefit plans under title I of the Employee Retirement In-
come Security Act of 1974.
‘‘SEC. 2103. REQUIREMENTS APPLICABLE TO ALL HEALTH
BENEFIT PLANS.
‘‘(a) NO DISCRIMINATION BASED ON HEALTH STA-
TUS.—
‘‘(1) PROVISION OF SERVICES.—Except as pro-
vided under subsections (b) and (c), a health benefit
plan may not deny, limit, or condition the coverage
under (or benefits of) the plan based on the health
status, claims experience, receipt of health care,
medical history, or lack of evidence of insurability,
of an individual.