SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting Patients 
from Deceptive Health Plans Act’’. 
SEC. 2. MODIFYING EXCEPTED BENEFITS WITH RESPECT 
TO CERTAIN PLANS. 
(a) PUBLIC HEALTH SERVICE ACT.— 
(1) ADDITIONAL
REQUIREMENTS
FOR
EX-
CEPTED BENEFIT.—Section 2722(c)(2) of the Public 
Health Service Act (42 U.S.C. 300gg–21(c)(2)) is 
amended— 
(A) in subparagraph (B), by striking 
‘‘sponsor.’’ and inserting ‘‘sponsor, or with re-
spect to individual coverage, under any health 
insurance coverage maintained by the same 
health insurance issuer.’’; and 
(B) by adding at the end the following: 
‘‘(D) Such benefits are paid without regard 
to, and do not vary based on, the severity of the 
illness, injury, diagnosis, or other characteris-
tics related to treatment for which such benefits 
are paid. 
‘‘(E) With respect to such benefits, the 
separate policy, certificate, or contract of insur-
ance is provided only to an individual enrolled 
in minimum essential coverage (as defined in 
section 5000A(f) of the Internal Revenue Code 
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of 1986), and such minimum essential cov-
erage’s share of the total allowed costs (as de-
termined 
for 
purposes 
of 
section 
36B(c)(2)(C)(ii) of such Code) of benefits pro-
vided under such minimum essential coverage is 
greater than or equal to 60 percent of such 
costs.’’. 
(2) MODIFICATION
OF
CERTAIN
EXCEPTED 
BENEFITS.—Section 2791(c) of the Public Health 
Service Act (42 U.S.C. 300gg–91(c)) is amended— 
(A) in paragraph (1)(A), by striking ‘‘acci-
dent’’ and all that follows through ‘‘combination 
thereof’’, and inserting ‘‘disability income insur-
ance’’; and 
(B) in paragraph (3), by adding at the end 
the following: 
‘‘(C) Coverage only for accident.’’. 
(b) EMPLOYEE
RETIREMENT
INCOME
SECURITY 
ACT.— 
(1) ADDITIONAL
REQUIREMENTS
FOR
EX-
CEPTED BENEFITS.—Section 732(c)(2) of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1191a(c)(2)) is amended by adding at the 
end the following: 
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‘‘(D) Such benefits are paid without regard 
to, and do not vary based on, the severity of the 
illness, injury, diagnosis, or other characteris-
tics related to treatment for which such benefits 
are paid. 
‘‘(E) With respect to such benefits, the 
separate policy, certificate, or contract of insur-
ance is provided only to a participant or bene-
ficiary enrolled in minimum essential coverage 
(as defined in section 5000A(f) of the Internal 
Revenue Code of 1986), and such minimum es-
sential coverage’s share of the total allowed 
costs (as determined for purposes of section 
36B(c)(2)(C)(ii) of such Code) of benefits pro-
vided under such minimum essential coverage is 
greater than or equal to 60 percent of such 
costs.’’. 
(2) MODIFICATION
OF
CERTAIN
EXCEPTED 
BENEFITS.—Section 733(c) of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 
1191b(c)) is amended— 
(A) in paragraph (1)(A), by striking ‘‘acci-
dent’’ and all that follows through ‘‘combination 
thereof’’, and inserting ‘‘disability income insur-
ance’’; and 
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(B) in paragraph (3), by adding at the end 
the following: 
‘‘(C) Coverage only for accident.’’. 
(c) INTERNAL REVENUE CODE.— 
(1) ADDITIONAL
REQUIREMENTS
FOR
EX-
CEPTED BENEFITS.—Section 9831(c)(2) of the In-
ternal Revenue Code of 1986 is amended by adding 
at the end the following: 
‘‘(D) Such benefits are paid without regard 
to, and do not vary based on, the severity of the 
illness, injury, diagnosis, or other characteris-
tics related to treatment for which such benefits 
are paid. 
‘‘(E) With respect to such benefits, the 
separate policy, certificate, or contract of insur-
ance is provided only to a participant or bene-
ficiary enrolled in minimum essential coverage 
(as defined in section 5000A(f)), and such min-
imum essential coverage’s share of the total al-
lowed costs (as determined for purposes of sec-
tion 36B(c)(2)(C)(ii)) of benefits provided 
under such minimum essential coverage is 
greater than or equal to 60 percent of such 
costs.’’. 
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(2) MODIFICATION
OF
CERTAIN
EXCEPTED 
BENEFITS.—Section 9832(c) of the Internal Rev-
enue Code of 1986 is amended— 
(A) in paragraph (1)(A), by striking ‘‘acci-
dent’’ and all that follows through ‘‘combination 
thereof’’, and inserting ‘‘disability income insur-
ance’’; and 
(B) in paragraph (3), by adding at the end 
the following: 
‘‘(C) Coverage only for accident.’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall take effect beginning January 1, 2023, 
and shall apply with respect to policies issued, sold, or re-
newed on or after such date. 
Æ 
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