I
105TH CONGRESS
1ST SESSION
H. R. 1807
To impose a limitation on lifetime aggregate limits imposed by health plans.
IN THE HOUSE OF REPRESENTATIVES
JUNE 5, 1997
Ms. ESHOO (for herself, Mr. MCDERMOTT, Mr. SCHUMER, Mr. MILLER of
California, Mr. TIERNEY, and Mr. WEYGAND) introduced the following
bill; which was referred to the Committee on 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 impose a limitation on lifetime aggregate limits imposed
by health plans.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. AMENDMENTS TO THE EMPLOYEE RETIRE-
MENT INCOME SECURITY ACT OF 1974.
(a) IN GENERAL.—Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security
Act of 1974 (as added by section 603(a) of the Newborns’
and Mothers’ Health Protection Act of 1996 and amended
ing calendar year and who employs fewer than 20
employees on the first day of the plan year.
‘‘(3) APPLICATION OF CERTAIN RULES IN DE-
TERMINATION OF EMPLOYER SIZE.—For purposes of
this subsection—
‘‘(A) APPLICATION OF AGGREGATION RULE
FOR EMPLOYERS.—Rules similar to the rules
under subsections (b), (c), (m), and (o) of sec-
tion 414 of the Internal Revenue Code of 1986
shall apply for purposes of treating persons as
a single employer.
‘‘(B) EMPLOYERS NOT IN EXISTENCE IN
PRECEDING YEAR.—In the case of an employer
which was not in existence throughout the pre-
ceding calendar year, the determination of
whether such employer is a small employer shall
be based on the number of employees that it is
reasonably expected such employer will normally
employ on a typical business day in the current
calendar year.
‘‘(C) PREDECESSORS.—Any reference in
this subsection to an employer shall include a
reference to any predecessor of such employer.
‘‘(c) DEFINITION.—In this section, the term ‘aggre-
gate dollar lifetime limit’ means, with respect to benefits
under a group health plan or health insurance coverage,
a dollar limitation on the total amount that may be paid
with respect to such benefits under the plan or health in-
surance coverage with respect to an individual or other
coverage unit.’’.
(b) CLERICAL AMENDMENT.—The table of contents
in section 1 of such Act, as amended by section 603 of
the Newborns’ and Mothers’ Health Protection Act of
1996 and section 702 of the Mental Health Parity Act
of 1996, is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Limitation on lifetime aggregate limits.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to plan years begin-
ning on or after the date that is 2 years after the date
of enactment of this Act.
SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE GROUP MARKET.
(a) IN GENERAL.—Subpart 2 of part A of title
XXVII of the Public Health Service Act (as added by sec-
tion 604(a) of the Newborns’ and Mothers’ Health Protec-
tion Act of 1996 and amended by section 703(a) of the
Mental Health Parity Act of 1996) is amended by adding
at the end the following new section:
‘‘SEC. 2706. LIMITATION ON LIFETIME AGGREGATE LIMITS.
‘‘(a) IN GENERAL.—A group health plan and a health
insurance issuer providing health insurance coverage in
connection with a group health plan, may not impose an
aggregate dollar lifetime limit of less than—
‘‘(1) with respect to the first 3 plan years after
the effective date of this section, $5,000,000; and
‘‘(2) with respect to subsequent plan years,
$10,000,000;
with respect to benefits payable under the plan or cov-
erage.
‘‘(b) SMALL EMPLOYERS.—
‘‘(1) IN
GENERAL.—Subsection (a) shall not
apply to any group health plan (and group health in-
surance coverage offered in connection with a group
health plan) offered to or maintained for employees
of a small employer.
‘‘(2) SMALL
EMPLOYER.—For purposes of
paragraph (1), the term ‘small employer’ means an
employer who normally employed fewer than 20 em-
ployees on a typical business day during the preced-
ing calendar year and who employs fewer than 20
employees on the first day of the plan year.
‘‘(3) APPLICATION OF CERTAIN RULES IN DE-
TERMINATION OF EMPLOYER SIZE.—For purposes of
this subsection—
‘‘(A) APPLICATION OF AGGREGATION RULE
FOR EMPLOYERS.—Rules similar to the rules
under subsections (b), (c), (m), and (o) of sec-
tion 414 of the Internal Revenue Code of 1986
shall apply for purposes of treating persons as
a single employer.
‘‘(B) EMPLOYERS NOT IN EXISTENCE IN
PRECEDING YEAR.—In the case of an employer
which was not in existence throughout the pre-
ceding calendar year, the determination of
whether such employer is a small employer shall
be based on the number of employees that it is
reasonably expected such employer will normally
employ on a typical business day in the current
calendar year.
‘‘(C) PREDECESSORS.—Any reference in
this subsection to an employer shall include a
reference to any predecessor of such employer.
‘‘(c) DEFINITION.—In this section, the term ‘aggre-
gate dollar lifetime limit’ means, with respect to benefits
under a group health plan or health insurance coverage,
a dollar limitation on the total amount that may be paid
with respect to such benefits under the plan or health in-
surance coverage with respect to an individual or other
coverage unit.’’.
(b) EFFECTIVE DATE.—The amendment made by
this section shall apply with respect to plan years begin-
ning on or after the date that is 2 years after the date
of enactment of this Act.
Æ