I
104TH CONGRESS
1ST SESSION
H. R. 1610
To amend the Internal Revenue Code of 1986 to require employer-provided
group health plans to credit coverage under a prior group health plan
against any preexisting condition limitation.
IN THE HOUSE OF REPRESENTATIVES
MAY 11, 1995
Mr. THOMAS (for himself, Mr. STARK, Mrs. JOHNSON of Connecticut, Mr.
CARDIN, Mr. MCCRERY, Mr. MCDERMOTT, Mr. ENSIGN, Mr. KLECZKA,
Mr. CHRISTENSEN, Mr. LEWIS of Georgia, Mr. CRANE, Mr. HOUGHTON,
and Mr. SAM JOHNSON of Texas) introduced the following bill; which was
referred to the Committee on Ways and Means
A BILL
To amend the Internal Revenue Code of 1986 to require
employer-provided group health plans to credit coverage
under a prior group health plan against any preexisting
condition limitation.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. CREDIT FOR COVERAGE UNDER PRIOR GROUP
HEALTH PLAN AGAINST ANY PREEXISTING
CONDITION LIMITATION.
(a) IN GENERAL.—Section 4980B of the Internal
Revenue Code of 1986 is amended by redesignating sub-
section (g) as subsection (i) and by inserting after sub-
section (f) the following new subsections:
‘‘(g) PREEXISTING
CONDITION
LIMITATION
RE-
QUIREMENTS OF GROUP HEALTH PLANS.—
‘‘(1) IN GENERAL.—A group health plan meets
the requirements of this subsection only if the pre-
existing condition limitation period (if any) under
the plan with respect to any individual who com-
mences coverage under the plan after December 31,
1995, is reduced by the length of the aggregate pe-
riod of qualified prior coverage (if any) applicable to
such individual as of the date of such commence-
ment.
‘‘(2) PREEXISTING CONDITION LIMITATION PE-
RIOD.—For purposes of paragraph (1), the term
‘preexisting condition limitation period’ means, with
respect to coverage of an individual under a group
health plan, the period during which benefits with
respect to treatment of a condition of such individ-
ual are not provided based on the fact that the con-
dition was preexisting.
‘‘(3) AGGREGATE PERIOD OF QUALIFIED PRIOR
COVERAGE.—
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the term ‘aggregate period of quali-
fied prior coverage’ means, with respect to com-
mencement of coverage of an individual under
a group health plan, the aggregate of the quali-
fied coverage periods of such individual occur-
ring before the date of such commencement.
Such period shall be treated as zero if there is
more than a 60-day break in coverage under a
group health plan between the date the most re-
cent qualified coverage period ends and the date
of such commencement.
‘‘(B) QUALIFIED COVERAGE PERIOD.—
‘‘(i) IN
GENERAL.—For purposes of
this paragraph, the term ‘qualified cov-
erage period’ means, with respect to an in-
dividual, any period of coverage of the in-
dividual under a group health plan.
‘‘(ii) DISREGARDING PERIODS BEFORE
BREAKS
IN
COVERAGE.—Such term does
not include any period occurring before
any 60-day break in coverage under a
group health plan.
‘‘(C) WAITING PERIOD NOT TREATED AS A
BREAK
IN
COVERAGE.—For purposes of sub-
paragraphs (A) and (B), any period that is in
a waiting period for any coverage under a
(as defined in subsection (g)(3)(A)) of greater than
zero.
‘‘(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as preventing a group
health plan from establishing preexisting condition
limitations and restrictions consistent with sub-
section (g).’’
(b) NOTICE.—Subsection (f)(6)(A) of section 4980B
of such Code is amended by inserting before the period
the following: ‘‘and subsections (g) and (h)’’.
(c) TECHNICAL AMENDMENTS.—
(1) Subsection (a) of section 4980B of such
Code is amended by striking ‘‘the requirements of’’
and all that follows and inserting ‘‘the requirements
of—
‘‘(1) subsection (f) with respect to any qualified
beneficiary,
‘‘(2) subsection (g) with respect to any individ-
ual covered under the group health plan, or
‘‘(3) subsection (h) with respect to any individ-
ual.’’
(2) Subsection (f) of section 4980B of such
Code is further amended—
(A) in paragraph (2)(B)(i)(III), by striking
‘‘(g)(1)(D)(iii)’’ and inserting ‘‘(i)(1)(D)(iii)’’,
(B) in paragraph (2)(B)(iv)(II), by strik-
ing ‘‘(g)(1)(D)’’ and inserting ‘‘(i)(1)(D)’’,
(C) in the last sentence of paragraph (3),
by 
striking 
‘‘(g)(1)(D)’’ 
and 
inserting
‘‘(i)(1)(D)’’, and
(D) in paragraph (5)(B), by striking
‘‘(g)(1)’’ and inserting ‘‘(i)(1)’’.
(d) EFFECTIVE DATE.— The amendments made by
this section shall apply to plan years beginning after De-
cember 31, 1995.
Æ