H. R. 3103—19
(ii) SPECIAL RULE FOR CERTAIN PERIODS.—The Sec-
retary of Labor, consistent with section 104, shall pro-
vide for a process whereby individuals who need to
establish creditable coverage for periods before July
1, 1996, and who would have such coverage credited
but for clause (i) may be given credit for creditable
coverage for such periods through the presentation
of documents or other means.
(B) CERTIFICATIONS, ETC.—
(i) IN GENERAL.—Subject to clauses (ii) and (iii),
subsection (e) of section 701 of the Employee Retire-
ment Income Security Act of 1974 (as added by this
section) shall apply to events occurring after June 30,
1996.
(ii) NO CERTIFICATION REQUIRED TO BE PROVIDED
BEFORE
JUNE
1, 1997.—In no case is a certification
required to be provided under such subsection before
June 1, 1997.
(iii) CERTIFICATION ONLY ON WRITTEN REQUEST FOR
EVENTS OCCURRING BEFORE OCTOBER 1, 1996.—In the
case of an event occurring after June 30, 1996, and
before October 1, 1996, a certification is not required
to be provided under such subsection unless an individ-
ual (with respect to whom the certification is otherwise
required to be made) requests such certification in
writing.
(C) TRANSITIONAL RULE.—In the case of an individual
who seeks to establish creditable coverage for any period
for which certification is not required because it relates
to an event occurring before June 30, 1996—
(i) the individual may present other credible evi-
dence of such coverage in order to establish the period
of creditable coverage; and
(ii) a group health plan and a health insurance
issuer shall not be subject to any penalty or enforce-
ment action with respect to the plan’s or issuer’s credit-
ing (or not crediting) such coverage if the plan or
issuer has sought to comply in good faith with the
applicable requirements under the amendments made
by this section.
(3) SPECIAL
RULE
FOR
COLLECTIVE
BARGAINING
AGREE-
MENTS.—Except as provided in paragraph (2), in the case of
a group health plan maintained pursuant to one or more collec-
tive bargaining agreements between employee representatives
and one or more employers ratified before the date of the
enactment of this Act, part 7 of subtitle B of title I of Employee
Retirement Income Security Act of 1974 (other than section
701(e) thereof) shall not apply to plan years beginning before
the later of—
(A) the date on which the last of the collective bargain-
ing 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) July 1, 1997.
For purposes of subparagraph (A), any plan amendment made
pursuant to a collective bargaining agreement relating to the
plan which amends the plan solely to conform to any require-
H. R. 3103—20
ment of such part shall not be treated as a termination of
such collective bargaining agreement.
(4) TIMELY REGULATIONS.—The Secretary of Labor, consist-
ent with section 104, shall first issue by not later than April
1, 1997, such regulations as may be necessary to carry out
the amendments made by this section.
(5) LIMITATION ON ACTIONS.—No enforcement action shall
be taken, pursuant to the amendments made by this section,
against a group health plan or health insurance issuer with
respect to a violation of a requirement imposed by such amend-
ments before January 1, 1998, or, if later, the date of issuance
of regulations referred to in paragraph (4), if the plan or issuer
has sought to comply in good faith with such requirements.
SEC. 102. THROUGH THE PUBLIC HEALTH SERVICE ACT.
(a) IN GENERAL.—The Public Health Service Act is amended
by adding at the end the following new title:
‘‘TITLE XXVII—ASSURING PORTABILITY,
AVAILABILITY, 
AND 
RENEWABILITY
OF HEALTH INSURANCE COVERAGE
‘‘PART A—GROUP MARKET REFORMS
‘‘Subpart 1—Portability, Access, and Renewability Requirements
‘‘SEC. 2701. INCREASED 
PORTABILITY 
THROUGH 
LIMITATION 
ON
PREEXISTING CONDITION EXCLUSIONS.
‘‘(a) LIMITATION ON PREEXISTING CONDITION EXCLUSION PERIOD;
CREDITING FOR PERIODS OF PREVIOUS COVERAGE.—Subject to sub-
section (d), a group health plan, and a health insurance issuer
offering group health insurance coverage, may, with respect to
a participant or beneficiary, impose a preexisting condition exclusion
only if—
‘‘(1) such exclusion relates to a condition (whether physical
or mental), regardless of the cause of the condition, for which
medical advice, diagnosis, care, or treatment was recommended
or received within the 6-month period ending on the enrollment
date;
‘‘(2) such exclusion extends for a period of not more than
12 months (or 18 months in the case of a late enrollee) after
the enrollment date; and
‘‘(3) the period of any such preexisting condition exclusion
is reduced by the aggregate of the periods of creditable coverage
(if any, as defined in subsection (c)(1)) applicable to the partici-
pant or beneficiary as of the enrollment date.
‘‘(b) DEFINITIONS.—For purposes of this part—
‘‘(1) PREEXISTING CONDITION EXCLUSION.—
‘‘(A) IN
GENERAL.—The term ‘preexisting condition
exclusion’ means, with respect to coverage, a limitation
or exclusion of benefits relating to a condition based on
the fact that the condition was present before the date
of enrollment for such coverage, whether or not any medical
advice, diagnosis, care, or treatment was recommended
or received before such date.
H. R. 3103—21
‘‘(B) TREATMENT
OF
GENETIC
INFORMATION.—Genetic
information shall not be treated as a condition described
in subsection (a)(1) in the absence of a diagnosis of the
condition related to such information.
‘‘(2) ENROLLMENT
DATE.—The term ‘enrollment date’
means, with respect to an individual covered under a group
health plan or health insurance coverage, the date of enrollment
of the individual in the plan or coverage or, if earlier, the
first day of the waiting period for such enrollment.
‘‘(3) LATE ENROLLEE.—The term ‘late enrollee’ means, with
respect to coverage under a group health plan, a participant
or beneficiary who enrolls under the plan other than during—
‘‘(A) the first period in which the individual is eligible
to enroll under the plan, or
‘‘(B) a special enrollment period under subsection (f).
‘‘(4) WAITING PERIOD.—The term ‘waiting period’ means,
with respect to a group health plan and an individual who
is a potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the individ-
ual is eligible to be covered for benefits under the terms of
the plan.
‘‘(c) RULES RELATING TO CREDITING PREVIOUS COVERAGE.—
‘‘(1) CREDITABLE COVERAGE DEFINED.—For purposes of this
title, the term ‘creditable coverage’ means, with respect to an
individual, coverage of the individual under any of the following:
‘‘(A) A group health plan.
‘‘(B) Health insurance coverage.
‘‘(C) Part A or part B of title XVIII of the Social
Security Act.
‘‘(D) Title XIX of the Social Security Act, other than
coverage consisting solely of benefits under section 1928.
‘‘(E) Chapter 55 of title 10, United States Code.
‘‘(F) A medical care program of the Indian Health
Service or of a tribal organization.
‘‘(G) A State health benefits risk pool.
‘‘(H) A health plan offered under chapter 89 of
title 5, United States Code.
‘‘(I) A public health plan (as defined in regulations).
‘‘(J) A health benefit plan under section 5(e) of the
Peace Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of cov-
erage of excepted benefits (as defined in section 2791(c)).
‘‘(2) NOT COUNTING PERIODS BEFORE SIGNIFICANT BREAKS
IN COVERAGE.—
‘‘(A) IN GENERAL.—A period of creditable coverage shall
not be counted, with respect to enrollment of an individual
under a group health plan, if, after such period and before
the enrollment date, there was a 63-day period during
all of which the individual was not covered under any
creditable coverage.
‘‘(B) WAITING PERIOD NOT TREATED AS A BREAK IN COV-
ERAGE.—For purposes of subparagraph (A) and subsection
(d)(4), any period that an individual is in a waiting period
for any coverage under a group health plan (or for group
health insurance coverage) or is in an affiliation period
(as defined in subsection (g)(2)) shall not be taken into
H. R. 3103—22
account in determining the continuous period under
subparagraph (A).
‘‘(3) METHOD OF CREDITING COVERAGE.—
‘‘(A) STANDARD METHOD.—Except as otherwise provided
under subparagraph (B), for purposes of applying sub-
section (a)(3), a group health plan, and a health insurance
issuer offering group health insurance coverage, shall count
a period of creditable coverage without regard to the specific
benefits covered during the period.
‘‘(B) ELECTION
OF
ALTERNATIVE
METHOD.—A group
health plan, or a health insurance issuer offering group
health insurance, may elect to apply subsection (a)(3) based
on coverage of benefits within each of several classes or
categories of benefits specified in regulations rather than
as provided under subparagraph (A). Such election shall
be made on a uniform basis for all participants and bene-
ficiaries. Under such election a group health plan or issuer
shall count a period of creditable coverage with respect
to any class or category of benefits if any level of benefits
is covered within such class or category.
‘‘(C) PLAN NOTICE.—In the case of an election with
respect to a group health plan under subparagraph (B)
(whether or not health insurance coverage is provided in
connection with such plan), the plan shall—
‘‘(i) prominently state in any disclosure statements
concerning the plan, and state to each enrollee at the
time of enrollment under the plan, that the plan has
made such election, and
‘‘(ii) include in such statements a description of
the effect of this election.
‘‘(D) ISSUER NOTICE.—In the case of an election under
subparagraph (B) with respect to health insurance coverage
offered by an issuer in the small or large group market,
the issuer—
‘‘(i) shall prominently state in any disclosure state-
ments concerning the coverage, and to each employer
at the time of the offer or sale of the coverage, that
the issuer has made such election, and
‘‘(ii) shall include in such statements a description
of the effect of such election.
‘‘(4) ESTABLISHMENT OF PERIOD.—Periods of creditable cov-
erage with respect to an individual shall be established through
presentation of certifications described in subsection (e) or in
such other manner as may be specified in regulations.
‘‘(d) EXCEPTIONS.—
‘‘(1) EXCLUSION NOT APPLICABLE TO CERTAIN NEWBORNS.—
Subject to paragraph (4), a group health plan, and a health
insurance issuer offering group health insurance coverage, may
not impose any preexisting condition exclusion in the case
of an individual who, as of the last day of the 30-day period
beginning with the date of birth, is covered under creditable
coverage.
‘‘(2) EXCLUSION NOT APPLICABLE TO CERTAIN ADOPTED CHIL-
DREN.—Subject to paragraph (4), a group health plan, and
a health insurance issuer offering group health insurance cov-
erage, may not impose any preexisting condition exclusion in
the case of a child who is adopted or placed for adoption