I
104TH CONGRESS
1ST SESSION
H. R. 1012
To require equal coverage under a health plan for all children under the
age of 27 of an individual who enrolls in the plan under a family
class of enrollment.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 22, 1995
Mr. BAKER of California (for himself, Mr. LATOURETTE, and Mr. MILLER of
Florida) introduced the following bill; which was referred to the Commit-
tee on Commerce and, in addition, to the Committees on Economic and
Educational Opportunities and the Judiciary, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
A BILL
To require equal coverage under a health plan for all children
under the age of 27 of an individual who enrolls in
the plan under a family class of enrollment.
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 ‘‘Family Health Care
Coverage Act’’.
SEC. 2. FAMILY COVERAGE OF CHILDREN.
(a) IN GENERAL.—In the case of an individual en-
rolled in a health plan under a family class of enrollment,
the carrier providing the plan, or the plan sponsor spon-
soring or maintaining the plan, shall offer and provide
equal coverage under the plan to any child of the individ-
ual, if the child elects to receive coverage pursuant to such
family enrollment.
(b) DEFINITIONS.—For purposes of this section:
(1) CARRIER.—The term ‘‘carrier’’ means a li-
censed insurance company, a hospital or medical
service corporation (including an existing Blue Cross
or Blue Shield organization, within the meaning of
section 833(c)(2) of the Internal Revenue Code of
1986), a health maintenance organization, or any
other entity (other than a plan sponsor) licensed or
certified by a State to provide health insurance or
health benefits.
(2) CHILD.—
(A) IN
GENERAL.—The term ‘‘child’’
means an individual who—
(i) is less than 27 years of age;
(ii) has never been married;
(iii) has no dependents; and
(iv) has a parent-child relationship
with another individual who is eligible to
enroll in a health plan under a family class
of enrollment.
(B) APPLICATION OF STATE LAW.—Deter-
mination of whether a child has a parent-child
relationship with another individual shall be
made in accordance with applicable State law.
(3) FAMILY
CLASS
OF
ENROLLMENT.—The
terms ‘‘family class of enrollment’’ and ‘‘family en-
rollment’’ mean enrollment in a health plan under a
class of enrollment that provides coverage for—
(A) an unmarried individual and 1 or more
children; or
(B) a married couple and 1 or more chil-
dren.
(4) GROUP HEALTH PLAN.—The term ‘‘group
health plan’’ means an employee welfare benefit plan
(as defined in section 3(1) of the Employee Retire-
ment Income Security Act of 1974) providing medi-
cal care (as defined in section 213(d) of the Internal
Revenue Code of 1986) to participants or bene-
ficiaries (as defined in section 3 of the Employee Re-
tirement Income Security Act of 1974) directly or
through insurance, reimbursement, or otherwise.
(5) HEALTH PLAN.—The term ‘‘health plan’’
means—
(A) any contract of health insurance, in-
cluding any hospital or medical service policy or
certificate, hospital or medical service plan con-
tract, or health maintenance organization group
contract, that is provided by a carrier; or
(B) a group health plan, an employee wel-
fare benefit plan, a multiple employer welfare
arrangement, or other arrangement insofar as
the plan or arrangement provides health bene-
fits and is funded in a manner other than
through the purchase of one or more policies or
contracts described in subparagraph (A).
(6) PLAN SPONSOR.—The term ‘‘plan sponsor’’
means—
(A) a plan sponsor described in section
3(16)(B)(iii) of Employee Retirement Income
Security Act of 1974, but only with respect to
a group health plan that is maintained by the
sponsor;
(B) an employer of an employee covered
under a health plan that is a multiple employer
welfare arrangement (as defined in section
3(40) of the Employee Retirement Income Se-
curity Act); or
(C) an employee organization that spon-
sors such a health plan.
SEC. 3. CIVIL MONEY PENALTY.
(a) VIOLATION.—Any individual who, or entity that,
the Secretary of Health and Human Services determines
has failed to comply with section 1 shall be subject, in
addition to any other penalties that may be prescribed by
law, to a civil money penalty of not more than $500 for
each such violation.
(b) PROCEDURES FOR IMPOSITION OF PENALTIES.—
The provisions of section 1128A of the Social Security Act
(other than subsections (a) and (b) and the second sen-
tence of subsection (f)) shall apply to the imposition of
a civil monetary penalty under this section in the same
manner as such provisions apply with respect to the impo-
sition of a penalty under section 1128A of such Act.
SEC. 4. INAPPLICABILITY OF MCCARRAN-FERGUSON ACT.
For purposes of section 2(b) of the Act of March 9,
1945 (15 U.S.C. 1012(b); commonly known as the
McCarran-Ferguson Act), this Act shall be considered to
specifically relate to the business of insurance.
SEC. 5. REGULATIONS.
The Secretary of Health and Human Services may
issue regulations to carry out this Act.
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