I
103D CONGRESS
1ST SESSION
H. R. 975
To amend title I of the Employee Retirement Income Security Act of 1974
to ensure nondiscrimination in benefits provided under group health
plans, and to provide for adequate notice of adoption of material coverage
restrictions under group health plans and effective remedies for violations
of such title with respect to such plans.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 18, 1993
Mr. HUGHES (for himself, Mr. BOEHLERT, Mr. ABERCROMBIE, Mr. DEFAZIO,
Mr. WAXMAN, Mr. STUDDS, Mr. MATSUI, Mr. FRANK of Massachusetts,
Ms. PELOSI, Mr. MCDERMOTT, Mr. BLACKWELL, Mr. BERMAN, Mr.
HEFNER, Mr. CONYERS, Mr. STARK, Mr. EVANS, and Mr. WYDEN) intro-
duced the following bill; which was referred to the Committee on Edu-
cation and Labor
A BILL
To amend title I of the Employee Retirement Income Secu-
rity Act of 1974 to ensure nondiscrimination in benefits
provided under group health plans, and to provide for
adequate notice of adoption of material coverage restric-
tions under group health plans and effective remedies
for violations of such title with respect to such plans.
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 ‘‘Group Health Plan
Nondiscrimination Act of 1993’’.
SEC. 2. PROTECTION FROM INTERFERENCE WITH RIGHTS.
Section 510 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1140) is amended—
(1) by inserting ‘‘(a) IN GENERAL.—’’ after
‘‘SEC. 510.’’; and
(2) by adding at the end the following new sub-
section:
‘‘(b) DISCRIMINATION BASED ON BENEFIT CLAIMS
UNDER GROUP HEALTH PLANS.—
‘‘(1) IN GENERAL.—It shall be unlawful dis-
crimination for purposes of subsection (a) to take
any action to cancel or reduce a benefit of a partici-
pant or beneficiary under a group health plan (by
plan amendment or plan termination, change in in-
sured status of the plan, change of insurer under the
plan, or any other means), if—
‘‘(A) such action is specifically related to
one or more particular diseases or medical con-
ditions,
‘‘(B) such participant or beneficiary is un-
dergoing, at the time such action is taken, a
course of treatment related to any such disease
or medical condition, and
‘‘(C) a valid claim under the plan reason-
ably related to such course of treatment has
been submitted to the plan by or on behalf of
such participant or beneficiary prior to the tak-
ing of such action.
‘‘(2) DEFINITIONS.—For purposes of this sub-
section—
‘‘(A) GROUP
HEALTH
PLAN.—The term
‘group health plan’ has the meaning provided in
section 607(1).
‘‘(B) CHANGE IN INSURED STATUS.—The
term ‘change in insured status’ of a plan means
a change to self-insured status or a change in
the extent to which benefits provided under the
plan are provided under a contract or policy of
insurance issued by an insurer under the plan.
‘‘(C) INSURER.—The term ‘insurer’ under
a plan means a person licensed by a State to
engage in the business of insurance who pro-
vides benefits under the plan under a contract
or policy of insurance issued by such person.
‘‘(D) VALID
CLAIM.—The term ‘valid
claim’ under a group health plan means a claim
which, at the time of its submission by or on
behalf of a participant or beneficiary, would
have entitled the participant or beneficiary to
benefits under the plan.’’.
SEC. 3. NONDISCRIMINATION IN LIFETIME BENEFIT COV-
ERAGE UNDER A GROUP HEALTH PLAN.
(a) IN GENERAL.—Part 5 of title I of the Employee
Retirement Income Security Act of 1974 is amended by
adding at the end the following:
‘‘NONDISCRIMINATION IN LIFETIME BENEFIT COVERAGE
UNDER A GROUP HEALTH PLAN
‘‘SEC. 516. (a) IN GENERAL.—It shall be unlawful
for a group health plan to discriminate among diseases
or medical conditions with respect to levels of lifetime ben-
efit coverage provided to similarly situated participants
and beneficiaries under the plan. For purposes of this sec-
tion, the term ‘lifetime benefit coverage’ provided to any
participant or beneficiary under a plan means the maxi-
mum benefit available under the plan in the aggregate to
such participant or beneficiary.
‘‘(b) LIMITATION.—Subsections (a) shall not apply
with respect to participants and their beneficiaries under
a group health plan if the requirements of paragraph (1)
or (2) are met as follows:
‘‘(1) COLLECTIVE
BARGAINING.—The require-
ments of this paragraph are met if—
‘‘(A) the participants consist of employees
covered by a collective bargaining agreement be-