(3) MEASUREMENT.—Once such standards are 
developed, performance of health care entities shall 
be measured against these standards. 
(c) HEALTH PLAN TRANSPARENCY AND ACCOUNT-
ABILITY.— 
(1) ACCOUNTABILITY.—The Secretary shall de-
velop standards to hold administrators of health ben-
efit plans accountable for their claims administrative 
practices, including overhead costs, delayed claims 
payments, errors, lost claims, and aggressive denial 
of claims. 
(2) DEVELOPMENT OF STANDARDS.—The Sec-
retary shall develop such standards through a col-
laborative process between the public-sector and pri-
vate-sector stakeholders to measure and make avail-
able to the public information on the performance of 
health benefit plan administrators during the period 
measured. Such information for each health benefit 
plan administrator shall include, for each health 
plan administered for each measurement period, the 
following: 
(A) Expense loadings added to the basic 
premium amount to cover expenses of the plan, 
including commissions, premium taxes, mar-
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keting support costs, and other similar ex-
penses. 
(B) The total number and cost of denied 
claims. 
(C) The total cost of denied claims that is 
transferred to providers. 
(D) The average out-of-pocket expense in-
curred by participants. 
(E) Consumer assessments regarding plan 
administration. 
(F) The relative efficiency and quality of 
claims administration and other administrative 
processes. 
(d) OVERSIGHT.—The Secretary shall have oversight 
responsibility to ensure that health benefit plans are ad-
ministered properly. 
TITLE V—AMENDMENTS RELAT-
ING TO PREEXISTING CONDI-
TION EXCLUSION 
SEC. 501. SHORT TITLE. 
This Act may be cited as the ‘‘Preexisting Condition 
Exclusion Patient Protection Act of 2008’’. 
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SEC. 502. AMENDMENTS RELATING TO PREEXISTING CON-
DITION EXCLUSIONS UNDER GROUP HEALTH 
PLANS. 
(a) AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974.— 
(1) REDUCTION IN LOOK-BACK PERIOD.—Sec-
tion 701(a)(1) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1181(a)(1)) is 
amended by striking ‘‘6-month period’’ and inserting 
‘‘30-day period’’. 
(2) REDUCTION
IN
PERMITTED
PREEXISTING 
CONDITION LIMITATION PERIOD.—Section 701(a)(2) 
of such Act (29 U.S.C. 1181(a)(2)) is amended by 
striking ‘‘12 months’’ and inserting ‘‘3 months’’, 
and by striking ‘‘18 months’’ and inserting ‘‘9 
months’’. 
(b) AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT.— 
(1) REDUCTION IN LOOK-BACK PERIOD.—Sec-
tion 2701(a)(1) of the Public Health Service Act (42 
U.S.C. 300gg(a)(1)) is amended by striking ‘‘6- 
month period’’ and inserting ‘‘30-day period’’. 
(2) REDUCTION
IN
PERMITTED
PREEXISTING 
CONDITION
LIMITATION
PERIOD.—Section 
2701(a)(2) of such Act (42 U.S.C. 300gg(a)(2)) is 
amended by striking ‘‘12 months’’ and inserting ‘‘3 
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months’’, and by striking ‘‘18 months’’ and inserting 
‘‘9 months’’. 
(c) AMENDMENTS
TO
THE INTERNAL REVENUE 
CODE OF 1986.— 
(1) REDUCTION IN LOOK-BACK PERIOD.—Para-
graph (1) of section 9801(a) of the Internal Revenue 
Code of 1986 (relating to limitation on preexisting 
condition exclusion period and crediting for periods 
of previous coverage) is amended by striking ‘‘6- 
month period’’ and inserting ‘‘30-day period’’. 
(2) REDUCTION
IN
PERMITTED
PREEXISTING 
CONDITION LIMITATION PERIOD.—Paragraph (2) of 
section 9801(a) of such Code is amended by striking 
‘‘12 months’’ and inserting ‘‘3 months’’, and by 
striking ‘‘18 months’’ and inserting ‘‘9 months’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply with respect to group health plans for 
plan years beginning after the end of the 12th cal-
endar month following the date of the enactment of 
this Act. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group 
health plan maintained pursuant to one or more col-
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lective bargaining agreements between employee rep-
resentatives and one or more employers ratified be-
fore the date of the enactment of this Act, the 
amendments made by this section shall not apply to 
plan years beginning before the earlier of— 
(A) the date on which the last of the col-
lective bargaining agreements relating to the 
plan terminates (determined without regard to 
any extension thereof agreed to after the date 
of the enactment of this Act), or 
(B) 3 years after the date of the enact-
ment of this Act. 
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement added by 
the amendments made by this section shall not be 
treated as a termination of such collective bar-
gaining agreement. 
SEC. 503. AMENDMENTS RELATING TO PREEXISTING CON-
DITION EXCLUSIONS IN HEALTH INSURANCE 
COVERAGE IN THE INDIVIDUAL MARKET. 
(a) APPLICABILITY OF GROUP HEALTH INSURANCE 
LIMITATIONS ON IMPOSITION OF PREEXISTING CONDI-
TION EXCLUSIONS.— 
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(1) IN GENERAL.—Section 2741 of the Public 
Health Service Act (42 U.S.C. 300gg–41) is amend-
ed— 
(A) by redesignating the second subsection 
(e) (relating to market requirements) and sub-
section (f) as subsections (f) and (g), respec-
tively; and 
(B) by adding at the end the following new 
subsection: 
‘‘(h) APPLICATION OF GROUP HEALTH INSURANCE 
LIMITATIONS ON IMPOSITION OF PREEXISTING CONDI-
TION EXCLUSIONS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
health insurance issuer that provides individual 
health insurance coverage may not impose a pre-
existing condition exclusion (as defined in subsection 
(b)(1)(A) of section 2701) with respect to such cov-
erage except to the extent that such exclusion could 
be imposed consistent with such section if such cov-
erage were group health insurance coverage. 
‘‘(2) LIMITATION.—In the case of an individual 
who— 
‘‘(A) is enrolled in individual health insur-
ance coverage; 
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