I 
108TH CONGRESS 
1ST SESSION H. R. 2321
To promote and facilitate expansion of coverage under group health plans, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 4, 2003
Mr. ANDREWS (for himself and Mr. PAYNE) introduced the following bill; 
which was referred to the Committee on Education and the Workforce, 
and in addition to the Committee on Ways and Means, for a period to 
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To promote and facilitate expansion of coverage under group 
health plans, and for other purposes.
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 ‘‘Group Health Plan 
Coverage Expansion Act of 2003’’.
SEC. 2. PROGRAM TO PROMOTE AND FACILITATE EXPAN-
SION OF COVERAGE UNDER GROUP HEALTH 
PLANS. 
(a) IN GENERAL.—Part 5 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 is 
amended by adding after section 518 (29 U.S.C. 1148) 
the following new section: 
‘‘SEC. 519. PROMOTION AND FACILITATION OF COVERAGE 
UNDER GROUP HEALTH PLANS. 
‘‘(a) IN GENERAL.—The Secretary shall establish by 
regulation a program—
‘‘(1) to promote and facilitate the availability to 
individuals of financial assistance provided by the 
Federal Government and by States and political sub-
divisions thereof for the purpose of assisting such in-
dividuals with the payment of employee contribu-
tions to group health plans, and 
‘‘(2) to promote and facilitate the establishment 
of alternative group purchasing or pooling arrange-
ments, such as purchasing cooperatives for small 
businesses, reinsurance pools, or high risk pools. 
‘‘(b) INTERGOVERNMENTAL CONSULTATION.—Under 
such program, the Secretary shall—
‘‘(1) provide for such ongoing consultation with 
agencies and instrumentalities of the Federal Gov-
ernment and of the States and political subdivisions
thereof as is necessary and appropriate to further 
the purposes such program, and 
‘‘(2) submit to each House of the Congress 
such recommendations for such legislative changes 
as the Secretary may, from time to time, consider to 
be appropriate to further the purposes of such pro-
gram. 
‘‘(c) SAFEGUARDS TO ENSURE MAINTENANCE OF 
CURRENT LEVELS
OF GOVERNMENTAL SUPPORT
FOR 
HEALTH CARE.—The Secretary shall ensure that partici-
pation in the program by any State or political subdivision 
thereof with respect to financial assistance described in 
subsection (a)(1) may not occur unless the Secretary finds 
that any reallocation of funds by such State or political 
subdivision in connection with participation in the pro-
gram does not result in a decrease in the number of indi-
viduals in the applicable jurisdiction who have substantial 
coverage for health benefits under either public or private 
programs.’’. 
(b) DEADLINE FOR ESTABLISHING PROGRAM.—The 
Secretary of Labor shall issue initial final regulations nec-
essary to carry out the program established under section 
518 of the Employee Retirement Income Security Act of 
1974 (added by section 2) not later than December 31, 
2004.
(c) CLERICAL AMENDMENTS.—The table of contents 
in section 1 of such Act is amended by inserting after the 
item relating to section 517 the following new items:
‘‘Sec. 518. Authority to postpone certain deadlines by reason of Presidentially 
declared disaster or terroristic or military actions. 
‘‘Sec. 519. Promotion and facilitation of coverage under group health plans.’’.
SEC. 3. NOTIFICATION TO PARTICIPANTS IN EMPLOYEE 
BENEFIT PLANS OF AVAILABILITY OF CHILD 
HEALTH ASSISTANCE UNDER SCHIP AND 
CASH BENEFITS AVAILABLE UNDER SSI. 
(a) IN GENERAL.—Section 104 of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1024) 
is amended—
(1) by redesignating subsection (d) as sub-
section (e); and 
(2) by inserting after subsection (c) the fol-
lowing new subsection: 
‘‘(d)(1) The administrator of an employee benefit 
plan shall include in each summary plan description, up-
dated summary plan description, and summary description 
of a modification or change to the plan which is furnished 
to participants, and shall provide separately to individuals 
claiming benefits under the plan, a summary description 
of—
‘‘(A) the child health assistance available under 
State child health plans under title XXI of the So-
cial Security Act, and
‘‘(B) the cash benefits available to eligible el-
derly or disabled individuals with limited income and 
resources under the supplemental security income 
program under title XVI of the Social Security Act. 
‘‘(2) The summary description required under para-
graph (1) shall—
‘‘(A) be in a form which shall be prescribed in 
regulations of the Secretary, in consultation with the 
Secretary of Health and Human Services, 
‘‘(B) be written in a manner calculated to be 
understood by the average plan participant, and 
‘‘(C) include—
‘‘(i) the appropriate telephone number, 
Internet website, and mailing address for the 
State program providing the assistance de-
scribed in paragraph (1)(A) in the State in 
which the participant or beneficiary resides, and 
‘‘(ii) the appropriate telephone number, 
Internet website, and mailing address for the 
supplemental security income program de-
scribed in paragraph (1)(B), 
together with the benefits information applicable to 
such programs.’’. 
(b) ENFORCEMENT.—Section 502(c)(1)(A) of such 
Act (29 U.S.C. 1132(c)(1)) is amended by striking ‘‘para-
graph (1) or (4) of section 606 or section 101(e)(1)’’ and 
inserting ‘‘section 101(e)(1), section 104(d), or paragraph 
(1) or (4) of section 606’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to summary plan de-
scriptions, updated summary plan descriptions, and sum-
mary descriptions of plan modifications or changes fur-
nished to participants or beneficiaries, and in connection 
with benefit claims filed, after December 31, 2003. 
SEC. 4. PROHIBITION OF LIFETIME LIMITS IN GROUP 
HEALTH PLANS. 
(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. PROHIBITION ON APPLICATION OF LIFETIME 
LIMITATIONS. 
‘‘(a) REQUIREMENT.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, may not impose any aggregate lifetime limit on 
benefits, including any category of benefits, under the plan 
or coverage. 
‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 
imposition of the requirement of this section shall be treat-
ed as a material modification in the terms of the plan de-
scribed in section 102(a)(1), for purposes of assuring no-
tice 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 
requirement apply.’’. 
(b) CONFORMING AMENDMENTS.—
(1) Section 731(c) of such Act (29 U.S.C. 
1191(c)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 714’’. 
(2) Section 732(a) of such Act (29 U.S.C. 
1191a(a)) is amended by striking ‘‘section 711’’ and 
inserting ‘‘sections 711 and 714’’. 
(3) 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. Prohibition on application of lifetime limitations.’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section apply with re-
spect to group health plans for plan years beginning 
on or after January 1, 2005. 
(2) COLLECTIVE BARGAINING EXCEPTION.—In 
the case of a group health plan maintained pursuant 
to 1 or more collective bargaining agreements be-
tween employee representatives and 1 or more em-
ployers ratified before the date of enactment of this 
Act, the amendments made by this section shall not 
apply to plan years beginning before the later of—
(A) the date on which the last collective 
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or 
(B) January 1, 2005. 
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 
this section shall not be treated as a termination of 
such collective bargaining agreement. 
SEC. 5. PROHIBITION OF DISCRIMINATION BASED ON PRE-
EXISTING CONDITIONS. 
(a) IN GENERAL.—Subpart B of part 7 of subtitle 
B of title I of the Employee Retirement Income Security 
Act of 1974 (as amended by section 4) is amended further 
by adding at the end the following new section:
‘‘SEC. 715. PROHIBITION ON DISCRIMINATION BASED ON 
PRE-EXISTING CONDITIONS. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insurance 
coverage, may not impose any change in the premium 
rates charged for coverage of participants and bene-
ficiaries under the plan so as to result in a premium 
charged to any such participant or beneficiary which is 
above that which is charged to otherwise similarly situated 
individuals solely on the basis of a pre-existing condition 
of such participant or beneficiary. 
‘‘(b) NOTICE UNDER GROUP HEALTH PLAN.—The 
imposition of the requirement of this section shall be treat-
ed as a material modification in the terms of the plan de-
scribed in section 102(a)(1), for purposes of assuring no-
tice 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 
requirement apply. 
‘‘(c) PRE-EXISTING CONDITION.—For purposes of 
this section, the term ‘pre-existing condition’ means, in 
connection with any change in premium rates charged for 
coverage of a participant or beneficiary, a medical condi-
tion of the participant or beneficiary that was present be-
fore the effective date of the change in premium rates, 
whether or not any medical advice, diagnosis, care, or 
treatment was recommended or received before such 
date.’’. 
(b) CONFORMING AMENDMENTS.—
(1) Section 732(a) of such Act (as amended by 
section 4 of this Act) is amended further by striking 
‘‘sections 711 and 714’’ and inserting ‘‘sections 711, 
714, and 715’’. 
(2) The table of contents in section 1 of such 
Act (as amended by section 4 of this Act) is amend-
ed further by inserting after the item relating to sec-
tion 714 the following new item:
‘‘Sec. 715. Prohibition on discrimination based on pre-existing conditions.’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section apply with re-
spect to group health plans for plan years beginning 
on or after January 1, 2005. 
(2) COLLECTIVE BARGAINING EXCEPTION.—In 
the case of a group health plan maintained pursuant 
to 1 or more collective bargaining agreements be-
tween employee representatives and 1 or more em-
ployers ratified before the date of enactment of this 
Act, the amendments made by this section shall not 
apply to plan years beginning before the later of—
(A) the date on which the last collective 
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or 
(B) January 1, 2005. 
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 
this section shall not be treated as a termination of 
such collective bargaining agreement. 
SEC. 6. PAYMENTS BY PENSION AND ANNUITY PLANS FOR 
COBRA BENEFITS. 
(a) IN GENERAL.—Section 401 of the Internal Rev-
enue Code of 1986 is amended by redesignating subsection 
(o) as subsection (p) and by inserting after subsection (n) 
the following new subsection: 
‘‘(o) PAYMENTS BY PLANS FOR CONTINUATION COV-
ERAGE PREMIUMS.—Under regulations prescribed by the 
Secretary, a pension or annuity plan shall not be consid-
ered as not satisfying the requirements of subsection (a) 
merely because the plan makes payments for premiums 
for continuation coverage under a group health plan on 
behalf of a qualified beneficiary which meet the require-