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104TH CONGRESS
2D SESSION
H. R. 4296
To require that health plans provide coverage for a minimum hospital stay
for mastectomies and lymph node disection for the treatment of breast cancer.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 28, 1996
Ms. DELAURO (for herself, Mr. DINGELL, Mr. SANDERS, Mr. COSTELLO, Mr.
FOGLIETTA, Mr. MORAN, Mrs. LOWEY, Mr. PALLONE, Mrs. MEEK of
Florida, Mr. LOBIONDO, Ms. PELOSI, Mr. NADLER, Ms. ESHOO, Mrs.
MALONEY, Ms. NORTON, Mrs. CLAYTON, and Ms. SLAUGHTER) intro-
duced the following bill; which was referred to the Committee on Com-
merce
A BILL
To require that health plans provide coverage for a minimum
hospital stay for mastectomies and lymph node disection
for the treatment of breast cancer.
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 ‘‘Breast Cancer Patient
Protection Act of 1996’’.
SEC. 2. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOR MASTECTOMIES AND LYMPH NODE
DISECTIONS 
FOR 
THE 
TREATMENT 
OF
BREAST CANCER.
(a) IN GENERAL.—A health plan that provides medi-
cal and surgical benefits with respect to the treatment of
breast cancer shall ensure that coverage is provided for
not less than 48 hours of inpatient care following a mas-
tectomy and not less than 24 hours of inpatient care fol-
lowing a lymph node disection for the treatment of breast
cancer.
(b) EXCEPTION.—Nothing in this section shall be
construed as requiring the provision of inpatient coverage
where the attending physician and patient determine that
a shorter period of hospital stay is appropriate.
(c) PROHIBITION.—In implementing the require-
ments of this section, a health plan may not modify the
terms and conditions of coverage based on the determina-
tion by an enrollee to request less than the minimum cov-
erage required under subsection (a).
(d) NOTICE.—A health plan shall provide notice to
each enrollee under such plan regarding the coverage re-
quired by this section in accordance with regulations pro-
mulgated by the Secretary of Health and Human Services.
Such notice shall be in writing and prominently positioned
in any literature or correspondence made available or dis-
tributed by the health plan and shall be transmitted—
(1) in the next mailing made by the plan to the
employee;
(2) as part of any yearly informational packet
sent to the enrollee; or
(3) not later than January 1, 1997;
whichever is earlier.
(e) HEALTH PLAN.—
(1) IN
GENERAL.—As used in this Act, the
term ‘‘health plan’’ means any plan or arrangement
which provides, or pays the cost of, health benefits.
(2) EXCLUSIONS.—Such term does not include
the following, or any combination thereof:
(A) Coverage only for accidental death or
dismemberment.
(B) Coverage providing wages or payments
in lieu of wages for any period during which the
employee is absent from work on account of
sickness or injury.
(C) A Medicare supplemental policy (as de-
fined in section 1882(g)(1) of the Social Secu-
rity Act).
(D) Coverage issued as a supplement to li-
ability insurance.
(E) Worker’s compensation or similar in-
surance.
(F) Automobile medical-payment insur-
ance.
(G) A long-term care policy, including a
nursing home fixed indemnity policy (unless the
Secretary determines that such a policy pro-
vides sufficiently comprehensive coverage of a
benefit so that it should be treated as a health
plan).
(H) Such other plan or arrangement as the
Secretary of Health and Human Services deter-
mines is not a health plan.
(3) CERTAIN PLANS INCLUDED.—Such term in-
cludes any plan or arrangement not described in any
subparagraph of paragraph (2) which provides for
benefit payments, on a periodic basis, for—
(A) a specified disease or illness, or
(B) period of hospitalization,
without regard to the costs incurred or services ren-
dered during the period to which the payments re-
late.
SEC. 3. EFFECTIVE DATE.
The provisions of section 2 shall apply to all health
plans offered, sold, issued, renewed, in effect, or operated
after the date of the enactment of this Act.
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