I
104TH CONGRESS
2D SESSION
H. R. 4300
To amend the Public Health Service Act to assure the availability of health
insurance coverage for children in the individual market in a manner
similar to guaranteed availability of individual health insurance coverage
for certain previously covered individuals under the Health Insurance
Portability and Accountability Act of 1996.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 28, 1996
Ms. FURSE introduced the following bill; which was referred to the Committee
on Commerce
A BILL
To amend the Public Health Service Act to assure the avail-
ability of health insurance coverage for children in the
individual market in a manner similar to guaranteed
availability of individual health insurance coverage for
certain previously covered individuals under the Health
Insurance Portability and Accountability Act of 1996.
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 ‘‘Children Health Insur-
ance Access Amendments of 1996’’.
SEC. 2. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
(a) IN GENERAL.—Title XXVII of the Public Health
Service Act, as added by section 111(a) of the Health In-
surance Portability and Accountability Act of 1996, is
amended by inserting after section 2741 the following new
section:
‘‘SEC. 2741A. GUARANTEED AVAILABILITY OF INDIVIDUAL
HEALTH INSURANCE COVERAGE TO UNIN-
SURED CHILDREN.
‘‘(a) GUARANTEED AVAILABILITY.—
‘‘(1) IN GENERAL.—Subject to the succeeding
subsections of this section, each health insurance is-
suer that offers health insurance coverage (as de-
fined in section 2791(b)(1)) in the individual market
in a State, in the case of an eligible child (as defined
in subsection (b)) desiring to enroll in individual
health insurance coverage—
‘‘(A) may not decline to offer such cov-
erage to, or deny enrollment of, such child;
‘‘(B) either (i) does not impose any pre-
existing condition exclusion (as defined in sec-
tion 2701(b)(1)(A)) with respect to such cov-
erage, or (ii) imposes such a preexisting condi-
tion exclusion only to the extent such an exclu-
sion may be imposed under section 2701(a) in
the case of an individual who is not a late en-
rollee; and
‘‘(C) shall provide that the premium for
the coverage is determined in a manner so that
the ratio of the premium for such eligible chil-
dren to the premium for eligible individuals de-
scribed in section 2741(b) does not exceed the
ratio of the actuarial value of such coverage
(calculated based on a standardized population
and a set of standardized utilization and cost
factors) for children to such actuarial value for
such coverage for such eligible individuals.
‘‘(2) SUBSTITUTION BY STATE OF ACCEPTABLE
ALTERNATIVE
MECHANISM.—The requirement of
paragraph (1) shall not apply to health insurance
coverage offered in the individual market in a State
in which the State is implementing an acceptable al-
ternative mechanism under section 2744.
‘‘(b) ELIGIBLE CHILD DEFINED.—In this part, the
term ‘eligible child’ means an individual born after Sep-
tember 30, 1983, who has not attained 16 years of age
and—
‘‘(1) who is a citizen or national of the United
States, an alien lawfully admitted for permanent res-
idence, or an alien otherwise permanently residing in
the United States under color of law;
‘‘(2) who is not eligible for coverage under (A)
a group health plan, (B) part A or part B of title
XVIII of the Social Security Act, or (C) a State plan
under title XIX of such Act (or any successor pro-
gram), and does not have other health insurance
coverage; and
‘‘(3) with respect to whom the most recent cov-
erage (if any, within the 1-year period ending on the
date coverage is sought under this section) was not
terminated based on a factor described in paragraph
(1) or (2) of section 2712(b) (relating to nonpay-
ment of premiums or fraud).
For purposes of paragraph (2)(A), the term ‘group health
plan’ does not include COBRA continuation coverage.
‘‘(c) INCORPORATION OF CERTAIN PROVISIONS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the provisions of subsections (c), (d), (e) and (f)
(other than paragraph (1)) of section 2741 and sec-
tion 2744 shall apply in relation to eligible children
under subsection (a) in the same manner as they
apply in relation to eligible individuals under section
2741(a).
‘‘(2) SPECIAL RULES FOR ACCEPTABLE ALTER-
NATIVE
MECHANISMS.—With respect to applying
section 2744 under paragraph (1)—
‘‘(A) 
the 
requirement 
in 
subsection
(a)(1)(B) shall be applied instead of the re-
quirement of section 2744(a)(1)(B);
‘‘(B) 
the 
requirement 
in 
subsection
(a)(1)(C) shall be applied instead of the re-
quirement of section 2744(a)(1)(D); and
‘‘(C) any deadline specified in such section
shall be 6 months after the deadline otherwise
specified.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as if included in the enact-
ment of section 2741 of the Public Health Service Act
under section 111(a) of the Health Insurance Portability
and Accountability Act of 1996.
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