I
105TH CONGRESS
2D SESSION
H. R. 4600
To amend the Public Health Service Act and the Employee Retirement
Income Security Act of 1974 to allow group and individual health insur-
ance coverage and group health plans to charge higher premiums to
smokers.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 18, 1998
Mr. KING of New York introduced the following bill; which was referred to
the Committee on Commerce, and in addition to the Committee on Edu-
cation and the Workforce, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned
A BILL
To amend the Public Health Service Act and the Employee
Retirement Income Security Act of 1974 to allow group
and individual health insurance coverage and group
health plans to charge higher premiums to smokers.
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 ‘‘Common Sense Smok-
ing Prevention Act of 1998’’.
SEC. 2. PENALTY FOR SMOKERS.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—(A) 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. 2706. STANDARD RELATING TO SMOKERS.
‘‘(a) REQUIREMENT.—In the case of benefits consist-
ing of medical care provided under a group health plan,
or in the case of group health insurance coverage offered
by a health insurance issuer in connection with a group
health plan, the plan or issuer—
‘‘(1) shall deny, cancel, or refuse to renew such
benefits or such coverage on the basis that a partici-
pant or beneficiary (or family member of a partici-
pant or beneficiary) refuses testing by a licensed
physician to determine whether or not such partici-
pant or beneficiary is a smoker; and
‘‘(2) shall increase the premiums for such bene-
fits or coverage by 10 percent for any participant or
beneficiary under the plan on the basis that a li-
censed physician has determined that the participant
or beneficiary (or family member of the participant
or beneficiary) is a smoker.
‘‘(b) DEFINITION OF FAMILY MEMBER.—For pur-
poses of this section the term ‘family member’ means, with
respect to an individual, a spouse or child of the individ-
ual.
‘‘(c) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
713(b) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.’’.
(B) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)), as amended by section 604(b)(2) of
Public Law 104–204, is amended by striking ‘‘sec-
tion 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 713. STANDARD RELATING SMOKERS.
‘‘(a) REQUIREMENT.—In the case of benefits consist-
ing of medical care provided under a group health plan,
or in the case of group health insurance coverage offered
by a health insurance issuer in connection with a group
health plan, the plan or issuer—
‘‘(1) shall deny, cancel, or refuse to renew such
benefits or such coverage on the basis that a partici-
pant or beneficiary (or family member of a partici-
pant or beneficiary) refuses testing by a licensed
physician to determine whether or not such partici-
pant or beneficiary is a smoker; and
‘‘(2) shall increase the premiums for such bene-
fits or coverage by 10 percent for any participant or
beneficiary under the plan on the basis that a li-
censed physician has determined that the participant
or beneficiary (or family member of the participant
or beneficiary) is a smoker.
‘‘(b) DEFINITION OF FAMILY MEMBER.—For pur-
poses of this section the term ‘family member’ means, with
respect to an individual, a spouse or child of the individ-
ual.
‘‘(c) 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) Section 731(c) of such Act (29 U.S.C.
1191(c)), as amended by section 603(b)(1) of Public
Law 104–204, is amended by striking ‘‘section 711’’
and inserting ‘‘sections 711 and 713’’.
(C) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(D) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standard relating to smokers.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—(1) Part B
of title XXVII of the Public Health Service Act is amend-
ed by inserting after section 2751 the following new sec-
tion:
‘‘SEC. 2752. STANDARD RELATING TO SMOKERS.
‘‘(a) IN
GENERAL.—The provisions of section
2706(a) 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 cov-
erage offered by a health insurance issuer in connection
with a group health plan in the small or large group mar-
ket.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 713(b) of the Employee Retirement Income Security
Act of 1974 with respect to the requirements referred to
in subsection (a) as if such section applied to such issuer
and such issuer were a group health plan.’’.
(2) Section 2762(b)(2) of such Act (42 U.S.C.
300gg–62(b)(2)), as added by section 605(b)(3)(B) of
Public Law 104–204, is amended by striking ‘‘section
2751’’ and inserting ‘‘sections 2751 and 2752’’.
(c) EFFECTIVE DATES.—(1) Subject to paragraph
(3), the amendments made by subsection (a) shall apply
with respect to group health plans for plan years begin-
ning on or after January 1, 1999.
(2) The amendment made by subsection (b) shall
apply with respect to health insurance coverage offered,
sold, issued, renewed, in effect, or operated in the individ-
ual market on or after such date.
(3) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made subsection (a) shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) January 1, 1999.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by subsection (a) shall not be
treated as a termination of such collective bargaining
agreement.
(d) COORDINATED REGULATIONS.—Section 104(1)
of Health Insurance Portability and Accountability Act of
1996 is amended by striking ‘‘this subtitle (and the
amendments made by this subtitle and section 401)’’ and
inserting ‘‘the provisions of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of
1974, the provisions of parts A and C of title XXVII of
the Public Health Service Act, and chapter 100 of the In-
ternal Revenue Code of 1986’’.
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