I
105TH CONGRESS
1ST SESSION
H. R. 1737
To amend the Public Health Service Act and the Employee Retirement
Income Security Act of 1974 to require that group and individual health
insurance coverage and group health plans provide adequate access to
services provided by obstetrician-gynecologists.
IN THE HOUSE OF REPRESENTATIVES
MAY 22, 1997
Mrs. LOWEY (for herself, Mr. LAZIO of New York, and Mr. COMBEST) intro-
duced the following bill; which was referred to the Committee on Com-
merce, and in addition to the Committee on Education and the
Workforce, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To amend the Public Health Service Act and the Employee
Retirement Income Security Act of 1974 to require that
group and individual health insurance coverage and
group health plans provide adequate access to services
provided by obstetrician-gynecologists.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Access to Women’s Health Care Act of 1997’’.
(b) FINDINGS.—Congress finds the following:
(1) Women’s health historically has received lit-
tle attention.
(2) A majority of women view their obstetri-
cian-gynecologist as their primary or sole physician.
(3) An obstetrician-gynecologist improves the
access to the health care of a woman by providing
primary and preventive health care throughout the
women’s lifetime, encompassing care of the whole
patient in addition to focusing on the processes of
the female reproductive system.
(4) 60 percent of all office visits to obstetrician-
gynecologists are for preventive care.
(5) Obstetrician-gynecologists refer their pa-
tients to other physicians less frequently than other
primary care providers, thus avoiding costly and
time-consuming referrals.
(6) 
Obstetrician-gynecologists 
manage 
the
health of women beyond the reproductive system,
and are uniquely qualified on the basis of education
and experience to provide basic health care services
to women.
(7) While more than 20 States have acted to
promote residents’ access to obstetrician-gyne-
cologists, patients in other States or in Federally-
governed health plans are not protected from access
restrictions or limitations.
SEC. 2. ASSURING ACCESS TO OBSTETRICAL AND GYNECO-
LOGICAL SERVICES UNDER GROUP HEALTH
PLANS AND GROUP AND INDIVIDUAL HEALTH
INSURANCE COVERAGE.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) Subpart 2 of part A of title XXVII of
the Public Health Service Act, as amended by sec-
tion 703(a) of Public Law 104–204, is amended by
adding at the end the following new section:
‘‘SEC. 2706. STANDARDS RELATING TO ACCESS TO OBSTET-
RICAL AND GYNECOLOGICAL SERVICES.
‘‘(a) IN GENERAL.—If a group health plan or health
insurance issuer, in the provision of health insurance cov-
erage in connection with a group health plan, requires or
provides for an enrollee to designate a participating pri-
mary care provider—
‘‘(1) the plan or issuer shall permit a female
enrollee to designate an obstetrician-gynecologist
who has agreed to be designated as such, as the en-
rollee’s primary care provider; and
‘‘(2) if such an enrollee has not designated such
a provider as a primary care provider, the plan or
issuer—
‘‘(A) may not require prior authorization
by the enrollee’s primary care provider or other-
wise for coverage of obstetric and gynecologic
care provided by a participating obstetrician-
gynecologist, or a participating health care pro-
fessional practicing in collaboration with the ob-
stetrician-gynecologist and in accordance with
State law, to the extent such care is otherwise
covered, and
‘‘(B) shall treat the ordering of other
gynecologic care by such a participating physi-
cian as the prior authorization of the primary
care provider with respect to such care under
the coverage.
‘‘(b) 
CONSTRUCTION.—Nothing 
in 
subsection
(a)(2)(B) shall waive any requirements of coverage relat-
ing to medical necessity or appropriateness with respect
to coverage of gynecologic care so ordered.
‘‘(c) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the
terms of the plan, solely for the purpose of avoiding
the requirements of this section;
‘‘(2) provide monetary payments or rebates to
women to encourage such women to accept less than
the minimum protections available under this sec-
tion; or
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider
provided care to an individual participant or bene-
ficiary in accordance with this section.
‘‘(d) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
713(d) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.
‘‘(f) NON-PREEMPTION
OF
MORE
PROTECTIVE
STATE LAW WITH RESPECT TO HEALTH INSURANCE IS-
SUERS.—Notwithstanding section 2723(a)(1) but subject
to section 2723(a)(2), this section shall not be construed
to supersede any provision of State law which establishes,
implements, or continues in effect any standard or re-
quirement solely relating to health insurance issuers in
connection with group health insurance coverage that pro-
vides greater protections to enrollees than the protections
provided under this section.’’.
(B) Section 2723 of such Act (42 U.S.C.
300gg–23) is amended—
(i) in subsection (a), by inserting ‘‘and sec-
tion 2706(f)’’ after ‘‘Subject to paragraph (2)’’,
and
(ii) in subsection (c), as amended by sec-
tion 604(b)(2) of Public Law 104–204, by
striking ‘‘section 2704’’ and inserting ‘‘sections
2704 and 2706’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974, as amended
by section 702(a) of Public Law 104–204, is amend-
ed by adding at the end the following new section:
‘‘SEC. 713. STANDARDS RELATING TO ACCESS TO OBSTET-
RICAL AND GYNECOLOGICAL SERVICES.
‘‘(a) IN GENERAL.—If a group health plan or health
insurance issuer, in the provision of health insurance cov-
erage in connection with a group health plan, requires or
provides for an enrollee to designate a participating pri-
mary care provider—
‘‘(1) the plan or issuer shall permit a female
enrollee to designate an obstetrician-gynecologist
who has agreed to be designated as such, as the en-
rollee’s primary care provider; and
‘‘(2) if such an enrollee has not designated such
a provider as a primary care provider, the plan or
issuer—
‘‘(A) may not require prior authorization
by the enrollee’s primary care provider or other-
wise for coverage of obstetric and gynecologic
care provided by a participating obstetrician-
gynecologist, or a participating health care pro-
fessional practicing in collaboration with the ob-
stetrician-gynecologist and in accordance with
State law, to the extent such care is otherwise
covered, and
‘‘(B) shall treat the ordering of other
gynecologic care by such a participating physi-
cian as the prior authorization of the primary
care provider with respect to such care under
the coverage.
‘‘(b) 
CONSTRUCTION.—Nothing 
in 
subsection
(a)(2)(B) shall waive any requirements of coverage relat-
ing to medical necessity or appropriateness with respect
to coverage of gynecologic care so ordered.
‘‘(c) PROHIBITIONS.—A group health plan, and a
health insurance issuer offering group health insurance
coverage in connection with a group health plan, may
not—
‘‘(1) deny to a woman eligibility, or continued
eligibility, to enroll or to renew coverage under the
terms of the plan, solely for the purpose of avoiding
the requirements of this section;
‘‘(2) provide monetary payments or rebates to
women to encourage such women to accept less than
the minimum protections available under this sec-
tion; or
‘‘(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider
provided care to an individual participant or bene-
ficiary in accordance with this section.
‘‘(d) NOTICE.—The imposition of the requirements of
this section shall be treated as a material modification in
the terms of the plan described in section 102(a)(1), for
purposes of assuring notice of such requirements under
the plan; except that the summary description required to
be provided under the last sentence of section 104(b)(1)
with respect to such modification shall be provided by not
later than 60 days after the first day of the first plan
year in which such requirements apply.
‘‘(e) LEVEL
AND TYPE
OF REIMBURSEMENTS.—
Nothing in this section shall be construed to prevent a
group health plan or a health insurance issuer offering
group health insurance coverage from negotiating the level
and type of reimbursement with a provider for care pro-
vided in accordance with this section.
‘‘(f) NON-PREEMPTION
OF
MORE
PROTECTIVE
STATE LAW WITH RESPECT TO HEALTH INSURANCE IS-
SUERS.—Notwithstanding section 731(a)(1) but subject to
section 731(a)(2), this section shall not be construed to
supersede any provision of State law which establishes, im-
plements, or continues in effect any standard or require-
ment solely relating to health insurance issuers in connec-
tion with group health insurance coverage that provides
greater protections to enrollees than the protections pro-
vided under this section.’’.
(B) Section 731 of such Act (29 U.S.C. 1191)
is amended—
(i) in subsection (a), by inserting ‘‘and sec-
tion 713(f)’’ after ‘‘subject to paragraph (2)’’,
and
(ii) in subsection (c), by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standards relating to access to obstetrical and gynecological serv-
ices.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act, as amend-
ed by section 605(a) of Public Law 104–204, is amended
by inserting after section 2751 the following new section:
‘‘SEC. 2752. STANDARDS RELATING TO ACCESS TO OBSTET-
RICAL AND GYNECOLOGICAL SERVICES.
‘‘(a) IN GENERAL.—The provisions of section 2706
(other than subsection (d)) shall apply to health insurance
coverage offered by a health insurance issuer in the indi-
vidual market in the same manner as it applies to health
insurance coverage offered by a health insurance issuer
in connection with a group health plan in the small or
large group market.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 713(d) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.
‘‘(c) NON-PREEMPTION
OF
MORE
PROTECTIVE
STATE LAW WITH RESPECT TO HEALTH INSURANCE IS-
SUERS.—Notwithstanding section 2762(a) but subject to
section 2762(b)(1), this section shall not be construed to
supersede any provision of State law which establishes, im-
plements, or continues in effect any standard or require-
ment solely relating to health insurance issuers in connec-
tion with group health insurance coverage that provides
greater protections to enrollees than the protections pro-
vided under this section.’’.
(2) Section 2762 of such Act (42 U.S.C. 300gg–62)
is amended—
(A) in subsection (a), by inserting ‘‘and section
2752(c)’’ after ‘‘Subject to subsection (b)’’, and
(B) in subsection (b)(2), as added by section
605(b)(3)(B) of Public Law 104–204, by striking
‘‘section 2751’’ and inserting ‘‘sections 2751 and
2752’’.
(c) EFFECTIVE DATES.—(1) Subject to paragraph
(3), the amendments made by subsection (a) shall apply
with respect to group health plans for plan years begin-
ning on or after January 1, 1998.
(2) The amendment made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individ-
ual market on or after such date.
(3) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made by subsection (a) shall not apply to
plan years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) January 1, 1998.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by subsection (a) shall not be
treated as a termination of such collective bargaining
agreement.
Æ