‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
compliance with this subclause, the 
employer may use any State-specific 
model notice developed in accordance 
with section 701(f)(3)(B)(i)(II) of the 
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Employee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
with the furnishing of the summary 
plan description as provided in section 
104(b) of the Employee Retirement 
Income Security Act of 1974. 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID- AND
CHIP-ELIGIBLE
INDIVID-
UALS.—In the case of an enrollee in a 
group health plan who is covered under a 
Medicaid plan of a State under title XIX 
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of the Social Security Act or under a State 
child health plan under title XXI of such 
Act, the plan administrator of the group 
health plan shall disclose to the State, 
upon request, information about the bene-
fits available under the group health plan 
in sufficient specificity, as determined 
under regulations of the Secretary of 
Health and Human Services in consulta-
tion with the Secretary that require use of 
the model coverage coordination disclosure 
form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Reau-
thorization Act of 2009, so as to permit 
the State to establish (under paragraph 
(2)(B), (3), or (10) of section 2105(c) of 
the Social Security Act or otherwise) the 
cost effectiveness of the State providing 
medical or child health assistance through 
premium assistance for the purchase of 
coverage under such group health plan and 
in order for the State to provide supple-
mental benefits required under paragraph 
(10)(E) of such section or other authority. 
‘‘(d) APPLICATION TO ASSOCIATION PLANS.— 
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‘‘(1) IN
GENERAL.—A group health plan or 
health insurance issuer that provides coverage to an 
association as required under section 2711(a)(2) 
shall accept every qualified individual that the asso-
ciation seeks health insurance coverage for, without 
regard to the health status of such individual. 
‘‘(2) DEFINITIONS
RELATED
TO
ASSOCIA-
TIONS.—For purposes of this subsection: 
‘‘(A) ASSOCIATION.—The term ‘associa-
tion’ means an association that— 
‘‘(i) has a constitution and bylaws; 
‘‘(ii) is determined by the Secretary to 
be an association which is operating in 
good faith for a primary purpose other 
than that of obtaining insurance; and 
‘‘(iii) has been in existence for a pe-
riod of at least 5 years. 
‘‘(B) DEPENDENT.—The term ‘dependent’, 
with respect to a qualified individual, has the 
meaning given such term in section 2714, with 
respect to a policy holder. 
‘‘(C) QUALIFIED
ACTUARY.—The term 
‘qualified actuary’ means a member in good 
standing of the American Academy of Actu-
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aries, or a successor organization approved by 
the Secretary. 
‘‘(D) QUALIFIED INDIVIDUALS.—The term 
‘qualified individual’ means, with respect to an 
association, an individual who meets any of the 
following: 
‘‘(i) A member of the association who 
has been such a member for a period of at 
least 30 days. 
‘‘(ii) An employee of such member 
who has been employed by such member 
for a period of at least 30 days. 
‘‘(iii) An employee of the association 
who has been employed by the association 
for a period of at least 30 days.’’. 
(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act (42 U.S.C. 
300gg–41 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2746. PROHIBITION OF PREEXISTING CONDITION EX-
CLUSIONS 
OR 
OTHER 
DISCRIMINATION 
BASED ON HEALTH STATUS. 
‘‘The provisions of section 2701 (other than subpara-
graphs (A)(ii) and (B) of subsection (c)(3)) shall apply 
to health insurance coverage offered to individuals by a 
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health insurance issuer in the individual market in the 
same manner as it applies to health insurance coverage 
offered by a health insurance issuer in the group market.’’. 
SEC. 6. NO LIFETIME OR ANNUAL LIMITS. 
(a) GROUP MARKET.—Subpart 2 of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–4 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2708. NO LIFETIME OR ANNUAL LIMITS. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group health insurance coverage 
may not establish— 
‘‘(1) lifetime limits on the dollar value of bene-
fits for any participant or beneficiary; or 
‘‘(2) unreasonable annual limits (within the 
meaning of section 223 of the Internal Revenue 
Code of 1986) on the dollar value of benefits for any 
participant or beneficiary. 
‘‘(b) PER BENEFICIARY LIMITS.—A group health 
plan or health insurance coverage may not place annual 
or lifetime per beneficiary limits on specific covered bene-
fits unless such limits are otherwise permitted under Fed-
eral or State law.’’. 
(b) INDIVIDUAL MARKET.—Subpart 2 of part B of 
title XXVII of the Public Health Service Act (42 U.S.C. 
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300gg–51 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2754. NO LIFETIME OR ANNUAL LIMITS. 
‘‘The provisions of section 2708 shall apply to health 
insurance coverage offered to individuals by a health in-
surance issuer in the individual market in the same man-
ner as it applies to health insurance coverage offered by 
a health insurance issuer in the group market.’’. 
SEC. 7. PROHIBITION ON RESCISSIONS. 
(a) GROUP MARKET.—Subpart 1 of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg 
et seq.) is amended by adding at the end the following: 
‘‘SEC. 2703. PROHIBITION ON RESCISSIONS. 
‘‘A group health plan and a health insurance issuer 
offering group health insurance coverage shall not rescind 
such plan or coverage with respect to an enrollee once the 
enrollee is covered under such plan or coverage involved, 
except that this section shall not apply to a covered indi-
vidual who has performed an act or practice that con-
stitutes fraud or makes an intentional misrepresentation 
of material fact as prohibited by the terms of the plan 
or coverage. Such plan or coverage may not be cancelled 
except with prior notice to the enrollee, and only as per-
mitted under section 2712(b).’’. 
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(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act (42 U.S.C. 
300gg–41 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2747. PROHIBITION ON RESCISSIONS. 
‘‘The provisions of section 2703 shall apply to health 
insurance coverage offered to individuals by a health in-
surance issuer in the individual market in the same man-
ner as it applies to health insurance coverage offered by 
a health insurance issuer in the group market.’’. 
SEC. 8. EXTENSION OF DEPENDENT COVERAGE. 
(a) GROUP MARKET.— 
(1) IN GENERAL.—Subpart 1 of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg et seq.) is amended by adding at the end: 
‘‘SEC. 2703A. EXTENSION OF DEPENDENT COVERAGE. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group health insurance coverage 
that provides dependent coverage of children shall con-
tinue to make such coverage available for such a depend-
ent after such dependent turns 18 years of age until the 
first of the following events occurs: 
‘‘(1) The dependent turns 26 years of age. 
‘‘(2) The dependent marries. 
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‘‘(3) Subject to subsection (c), the dependent no 
longer resides in the home of— 
‘‘(A) the policy holder through which such 
dependent is eligible for dependent coverage; or 
‘‘(B) in the case that the policy holder 
through which such dependent is eligible for de-
pendent coverage provides such coverage subject 
to an order to provide child support, the de-
pendent’s parent or legal guardian. 
‘‘(b) EXCEPTION FOR COLLEGE STUDENTS.—Para-
graph (3) of subsection (a) shall not apply to a dependent 
for any period of time during which such dependent is en-
rolled as a full-time student at a postsecondary edu-
cational institution (including an institution of higher edu-
cation as defined in section 102 of the Higher Education 
Act of 1965). 
‘‘(c) LIMITATION.—Nothing in this section shall re-
quire a plan or an issuer described in subsection (a) to 
make coverage available for a child of an individual receiv-
ing dependent coverage pursuant to this section. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to modify the definition of ‘depend-
ent’ as used in the Internal Revenue Code of 1986 with 
respect to the tax treatment of the cost of coverage.’’. 
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(2) REGULATIONS.—The Secretary shall pro-
mulgate regulations to define the dependents to 
which coverage shall be made available under section 
2703A of the Public Health Service Act, as added 
by paragraph (1). 
(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act (42 U.S.C. 
300gg–41 et seq.) is amended by adding at the end the 
following: 
‘‘SEC. 2748. EXTENSION OF DEPENDENT COVERAGE. 
‘‘The provisions of section 2703A shall apply to 
health insurance coverage offered to individuals by a 
health insurance issuer in the individual market in the 
same manner as it applies to health insurance coverage 
offered by a health insurance issuer in the group market.’’. 
SEC. 9. APPLICATION OF GROUP MARKET REFORMS TO 
ERISA AND THE INTERNAL REVENUE CODE 
OF 1986. 
(a) ERISA.— 
(1) IN GENERAL.—Subpart A of title VII of the 
Employee Retirement Income Security Act of 1974 
(29 U.S.C. 1181 et seq.) is amended— 
(A) by striking sections 701 and 703; and 
(B) by inserting before section 702 the fol-
lowing: 
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‘‘SEC. 701. APPLICATION OF CERTAIN PHSA REQUIRE-
MENTS. 
‘‘(a) IN GENERAL.—Sections 2701, 2703, 2703A, 
2708, 2711, and 2712 of the Public Health Service Act 
shall apply to group health plans, and health insurance 
issuers providing health insurance coverage in connection 
with group health plans, as if included in this subpart. 
‘‘(b) CONFLICT.—To the extent that any provision of 
this part conflicts with a provision of any section of the 
Public Health Service Act listed in subsection (a) with re-
spect to group health plans, or health insurance issuers 
providing health insurance coverage in connection with 
group health plans, the provisions of such sections shall 
apply.’’. 
(2) CONFORMING AMENDMENT.—The table of 
contents in section 1 of such Act (29 U.S.C. 1001 
note) is amended— 
(A) by striking the item related to section 
701 and inserting ‘‘Sec. 701. Application of cer-
tain PHSA requirements.’’; and 
(B) by striking the item related to section 
703. 
(b) INTERNAL REVENUE CODE
OF 1986.—Sub-
chapter A of chapter 100 of the Internal Revenue Code 
of 1986 (relating to group health plan requirements) is 
amended— 
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(1) by striking sections 9801 and 9803; and 
(2) by inserting before section 9802 the fol-
lowing: 
‘‘SEC. 9801. APPLICATION OF CERTAIN PHSA REQUIRE-
MENTS. 
‘‘(a) IN GENERAL.—Sections 2701, 2703, 2703A, 
2708, 2711, and 2712 of the Public Health Service Act 
shall apply to group health plans, and health insurance 
issuers providing health insurance coverage in connection 
with group health plans, as if included in this subchapter. 
‘‘(b) CONFLICT.—To the extent that any provision of 
this subchapter conflicts with a provision of any section 
of the Public Health Service Act listed in subsection (a) 
with respect to group health plans, or health insurance 
issuers providing health insurance coverage in connection 
with group health plans, the provisions of such sections 
shall apply.’’. 
SEC. 10. CATASTROPHIC PLAN. 
Subpart 1 of part B of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–41 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 2749. CATASTROPHIC PLAN. 
‘‘(a) IN GENERAL.—Each health insurance issuer 
that offers health insurance coverage in the individual 
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