(3) The term ‘‘abuse status’’ means the fact or
perception that a person is, has been, or may be a
subject of abuse, irrespective of whether the person
has sustained abuse-related medical conditions or
has incurred abuse-related claims.
(4) The term ‘‘health benefit plan’’ means any
public or private entity or program that provides for
payments for health care, including—
(A) a group health plan (as defined in sec-
tion 607 of the Employee Retirement Income
Security Act of 1974) or a multiple employer
welfare arrangement (as defined in section
3(40) of such Act) that provides health bene-
fits;
(B) any other health insurance arrange-
ment, including any arrangement consisting of
a hospital or medical expense incurred policy or
certificate, hospital or medical service plan con-
tract, or health maintenance organization sub-
scriber contract;
(C) workers’ compensation or similar in-
surance to the extent that it relates to workers’
compensation medical benefits (as defined by
the Federal Trade Commission); and
(D) automobile medical insurance to the
extent that it relates to medical benefits (as de-
fined by the Federal Trade Commission).
(5) The term ‘‘health carrier’’ means a person
that contracts or offers to contract on a risk-assum-
ing basis to provide, deliver, arrange for, pay for or
reimburse any of the cost of health care services, in-
cluding a sickness and accident insurance company,
a health maintenance organization, a nonprofit hos-
pital and health service corporation or any other en-
tity providing a plan of health insurance, health ben-
efits or health services.
(6) The term ‘‘insured’’ means a party named
on a policy, certificate, or health benefit plan, in-
cluding an individual, corporation, partnership, asso-
ciation, unincorporated organization or any similar
entity, as the person with legal rights to the benefits
provided by the policy, certificate, or health benefit
plan. For group insurance, such term includes a per-
son who is a beneficiary covered by a group policy,
certificate, or health benefit plan. For life insurance,
the term refers to the person whose life is covered
under an insurance policy.
(7) The term ‘‘insurer’’ means any person, re-
ciprocal exchange, interinsurer, Lloyds insurer, fra-
ternal benefit society, or other legal entity engaged
in the business of insurance, including agents, bro-
kers, adjusters, and third party administrators. The
term also includes health carriers, health benefit
plans, and life, disability, and property and casualty
insurers.
(8) The term ‘‘policy’’ means a contract of in-
surance, certificate, indemnity, suretyship, or annu-
ity issued, proposed for issuance or intended for is-
suance by an insurer, including endorsements or rid-
ers to an insurance policy or contract.
(9) The term ‘‘subject of abuse’’ means a per-
son against whom an act of abuse has been directed,
a person who has prior or current injuries, illnesses,
or disorders that resulted from abuse, or a person
who seeks, may have sought, or had reason to seek
medical or psychological treatment for abuse, protec-
tion, court-ordered protection, or shelter from abuse.
SEC. 3. DISCRIMINATORY ACTS PROHIBITED.
(a) IN GENERAL.—No insurer or health carrier may,
directly or indirectly, engage in any of the following acts
or practices on the basis that the applicant or insured,
or any person employed by the applicant or insured or
with whom the applicant or insured is known to have a
relationship or association, is, has been, or may be the
subject of abuse:
(1) Denying, refusing to issue, renew or reissue,
or canceling or otherwise terminating an insurance
policy or health benefit plan.
(2) Restricting, excluding, or limiting insurance
or health benefit plan coverage for losses incurred as
a result of abuse or denying a claim incurred by an
insured as a result of abuse, except as otherwise per-
mitted or required by State laws relating to life in-
surance beneficiaries.
(3) Adding a premium differential to any insur-
ance policy or health benefit plan.
(4) Terminating health coverage for a subject
of abuse because coverage was originally issued in
the name of the abuser and the abuser has divorced,
separated from, or lost custody of the subject of
abuse or the abuser’s coverage has terminated volun-
tarily or involuntarily and the subject of abuse does
not qualify for extension of coverage under part 6 of
subtitle B of title I or the Employee Retirement In-
come Security Act of 1974 (29 U.S.C. 1161 et seq.)
or 4980B of the Internal Revenue Code of 1986.
Nothing in this paragraph prohibits the insurer from
requiring the subject of abuse to pay the full pre-
mium for the subject’s coverage under the health
plan if the requirements are applied to all insureds
of the health carrier. The insurer may terminate
group coverage after the continuation coverage re-
quired by this paragraph has been in force for 18
months if it offers conversion to an equivalent indi-
vidual plan. The continuation of health coverage re-
quired by this paragraph shall be satisfied by any
extension of coverage under part 6 of subtitle B of
title I or the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1161 et seq.) or 4980B of
the Internal Revenue Code of 1986 provided to a
subject of abuse and is not intended to be in addi-
tion to any extension of coverage provided under
part 6 of subtitle B of title I or the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C.
1161 et seq.) or 4980B of the Internal Revenue
Code of 1986.
(b) USE OF INFORMATION.—
(1) IN GENERAL.—No person employed by or
contracting with an insurer or health benefit plan
may use, disclose, or transfer information relating to
an applicant’s or insured’s abuse status or abuse-re-
lated medical condition or the applicant’s or
insured’s status as a family member, employer, or
associate, person in a relationship with a subject of
abuse for any purpose unrelated to the direct provi-
sion of health care services unless such use, disclo-
sure, or transfer is required by an order of an entity
with authority to regulate insurance or an order of
a court of competent jurisdiction. In addition, such
a person may not disclose or transfer information re-
lating to an applicant’s or insured’s location or tele-
phone number. Nothing in this paragraph shall be
construed as limiting or precluding a subject of
abuse from obtaining the subject’s own insurance
records from an insurer.
(2) AUTHORITY
OF
SUBJECT
OF
ABUSE.—A
subject of abuse, at the absolute discretion of the
subject of abuse, may provide evidence of abuse to
an insurer for the limited purpose of facilitating
treatment of an abuse-related condition or dem-
onstrating that a condition is abuse-related. Nothing
in this paragraph shall be construed as authorizing
an insurer or health carrier to disregard such pro-
vided evidence.
SEC. 4. INSURANCE PROTOCOLS FOR SUBJECTS OF ABUSE.
Insurers shall develop and adhere to written policies
specifying procedures to be followed by employees, con-
tractors, producers, agents and brokers for the purpose
of protecting the safety and privacy of a subject of abuse
and otherwise implementing the provisions of this Act
when taking an application, investigating a claim, or tak-
ing any other action relating to a policy or claim involving
a subject of abuse.
SEC. 5. REASONS FOR ADVERSE ACTIONS.
An insurer that takes an action that adversely affects
a subject of abuse, shall advise the subject of abuse appli-
cant or insured of the specific reasons for the action in
writing. Reference to general underwriting practices or
guidelines does not constitute a specific reason.
SEC. 6. LIFE INSURANCE.
Nothing in this Act shall be construed to prohibit a
life insurer from declining to issue a life insurance policy
if the applicant or prospective owner of the policy is or
would be designated as a beneficiary of the policy, and
if—
(1) the applicant or prospective owner of the
policy lacks an insurable interest in the insured; or
(2) the applicant or prospective owner of the
policy is known, on the basis of police or court
records, to have committed an act of abuse against
the proposed insured.
SEC. 7. SUBROGATION WITHOUT CONSENT PROHIBITED.
Subrogation of claims resulting from abuse is prohib-
ited without the informed consent of the subject of abuse.
SEC. 8. ENFORCEMENT.
(a) FEDERAL TRADE COMMISSION.—The Federal
Trade Commission shall have the power to examine and
investigate any insurer to determine whether such insurer
has been or is engaged in any act or practice prohibited
by this Act. If the Federal Trade Commission determines
an insurer has been or is engaged in any act or practice
prohibited by this Act, the Commission may take action
against such insurer by the issuance of a cease and desist
order as if the insurer was in violation of section 5 of the
Federal Trade Commission Act. Such cease and desist
order may include any individual relief warranted under
the circumstances, including temporary, preliminary, and
permanent injunctive and compensatory relief.
(b) PRIVATE CAUSE OF ACTION.—An applicant or in-
sured who believes that the applicant or insured has been
adversely affected by an act or practice of an insurer in
violation of this Act may maintain an action against the
insurer in a Federal or State court of original jurisdiction.
Upon proof of such conduct by a preponderance of the
evidence, the court may award appropriate relief, includ-
ing temporary, preliminary, and permanent injunctive re-
lief and compensatory and punitive damages, as well as
the costs of suit and reasonable fees for the aggrieved indi-
vidual’s attorneys and expert witnesses. With respect to
compensatory damages, the aggrieved individual may
elect, at any time prior to the rendering of final judgment,
to recover in lieu of actual damages, an award of statutory
damages in the amount of $5,000 for each violation.
SEC. 9. EFFECTIVE DATE.
This Act shall apply with respect to any action taken
on or after the date of the enactment of this Act, except
that section 4 shall only apply to actions taken after the
expiration of 60 days after such date.
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