I 
108TH CONGRESS 
1ST SESSION H. R. 2095
To amend title XXVII of the Public Health Service Act and title I of 
the Employee Retirement Income Security Act of 1974 to require that 
group and individual health insurance coverage and group health plans 
provide comprehensive coverage for childhood immunization. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 14, 2003
Mr. GREEN of Texas (for himself, Mr. QUINN, Mr. PALLONE, Mr. BERMAN, 
Mr. MCDERMOTT, Mr. SANDLIN, Mr. EVANS, Mr. BROWN of Ohio, Mr. 
WAXMAN, Mr. GEORGE MILLER of California, Mr. GUTIERREZ, Mr. 
FROST, Mr. GORDON, and Mr. BELL) introduced the following bill; which 
was referred to the Committee on Energy and Commerce, 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 jurisdiction of the committee con-
cerned 
A BILL 
To amend title XXVII of the Public Health Service Act 
and title I of the Employee Retirement Income Security 
Act of 1974 to require that group and individual health 
insurance coverage and group health plans provide com-
prehensive coverage for childhood immunization.
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 ‘‘Comprehensive Insur-
ance Coverage of Childhood Immunization Act of 2003’’. 
SEC. 2. COMPREHENSIVE COVERAGE FOR CHILDHOOD IM-
MUNIZATION BY GROUP HEALTH PLANS AND 
HEALTH INSURANCE ISSUERS. 
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—Subpart 2 of part A of title XXVII of the 
Public Health Service Act is amended by adding at 
the end the following new section: 
‘‘SEC. 2707. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, shall provide for each plan year comprehensive 
coverage for routine immunizations for each individual 
who is a dependent of a participant or beneficiary under 
the plan and is under 19 years of age. 
‘‘(b) COMPREHENSIVE COVERAGE.—For purposes of 
this section, comprehensive coverage for routine immuni-
zations for a plan year consists of coverage, without 
deductibles, coinsurance, or other cost-sharing, for immu-
nizations (including the vaccine itself) in accordance with 
the most recent version of the Recommended Childhood 
Immunization Schedule issued prior to such plan year by
the Advisory Committee on Immunization Practices of the 
Centers for Disease Control and Prevention.’’. 
(2) ERISA AMENDMENTS.—
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 is amended by 
adding at the end the following new section: 
‘‘SEC. 714. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, shall provide for each plan year comprehensive 
coverage for routine immunizations for each individual 
who is a dependent of a participant or beneficiary under 
the plan and is under 19 years of age. 
‘‘(b) COMPREHENSIVE COVERAGE.—For purposes of 
this section, comprehensive coverage for routine immuni-
zations for a plan year consists of coverage, without 
deductibles, coinsurance, or other cost-sharing, for immu-
nizations (including the vaccine itself) in accordance with 
the most recent version of the Recommended Childhood 
Immunization Schedule issued prior to such plan year by 
the Advisory Committee on Immunization Practices of the 
Centers for Disease Control and Prevention.’’.
(B) CLERICAL AMENDMENT.—The table of 
contents in section 1 of such Act is amended by 
inserting after the item relating to section 713 
the following new item:
‘‘Sec. 714. Standard relating to coverage of childhood immunization.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—Part B of 
title XXVII of the Public Health Service Act is amended 
by inserting after section 2752 the following new section: 
‘‘SEC. 2753. STANDARD RELATING TO COVERAGE OF CHILD-
HOOD IMMUNIZATION. 
‘‘The provisions of section 2707 shall apply to health 
insurance coverage offered by a health insurance issuer 
in the individual market in the same manner as they apply 
to health insurance coverage offered by a health insurance 
issuer in connection with a group health plan in the small 
or large group market.’’. 
SEC. 3. COORDINATION OF ADMINISTRATION. 
The Secretary of Health and Human Services and the 
Secretary of Labor shall ensure, through the execution of 
an interagency memorandum of understanding among 
such Secretaries, that—
(1) regulations, rulings, and interpretations 
issued by such Secretaries relating to the same mat-
ter over which both such Secretaries have responsi-
bility under the provisions of this Act (and the
amendments made thereby) are administered so as 
to have the same effect at all times; and 
(2) coordination of policies relating to enforcing 
the same requirements through such Secretaries in 
order to have a coordinated enforcement strategy 
that avoids duplication of enforcement efforts and 
assigns priorities in enforcement. 
SEC. 4. EFFECTIVE DATES. 
(a) GROUP HEALTH PLANS AND GROUP HEALTH IN-
SURANCE COVERAGE.—Subject to subsection (c), the 
amendments made by section 2(a) apply with respect to 
group health plans for plan years beginning on or after 
January 1, 2004. 
(b) INDIVIDUAL HEALTH INSURANCE COVERAGE.—
The amendment made by section 2(b) applies with respect 
to health insurance coverage offered, sold, issued, re-
newed, in effect, or operated in the individual market on 
or after such date. 
(c) COLLECTIVE BARGAINING EXCEPTION.—In the 
case of a group health plan maintained pursuant to 1 or 
more collective bargaining agreements between employee 
representatives and 1 or more employers ratified before 
the date of enactment of this Act, the amendments made 
by section 2(a) shall not apply to plan years beginning 
before the later of—
(1) the earliest date as of which all such collec-
tive bargaining agreements relating to the plan have 
terminated (determined without regard to any exten-
sion thereof agreed to after the date of enactment of 
this Act), or 
(2) January 1, 2004. 
For purposes of paragraph (1), any plan amendment made 
pursuant to a collective bargaining agreement relating to 
the plan which amends the plan solely to conform to any 
requirement added by section 2(a) shall not be treated as 
a termination of such collective bargaining agreement.
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