I 
115TH CONGRESS 
1ST SESSION H. R. 1121 
To amend the Public Health Service Act to prohibit application of pre- 
existing condition exclusions and to guarantee availability of health insur-
ance coverage in the individual and group market, contingent on the 
enactment of legislation repealing the Patient Protection and Affordable 
Care Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 16, 2017 
Mr. WALDEN (for himself, Mr. LATTA, Mr. WALBERG, Mr. GUTHRIE, Mr. 
LANCE, Mr. MCKINLEY, Mr. BILIRAKIS, Mrs. MIMI WALTERS of Cali-
fornia, Mr. MITCHELL, Mr. BISHOP of Michigan, Mrs. WAGNER, Mrs. 
BROOKS of Indiana, Mr. KNIGHT, Mr. BUCSHON, Mr. CRAMER, Mr. ROD-
NEY DAVIS of Illinois, Mr. POLIQUIN, Ms. HERRERA BEUTLER, Mr. 
REICHERT, Mr. HARPER, Mr. UPTON, Mr. ROYCE of California, Mr. 
ALLEN, Mr. ABRAHAM, Mr. TIPTON, Mr. SMUCKER, Mr. KELLY of Penn-
sylvania, Mr. DENHAM, Mr. DONOVAN, Mr. FORTENBERRY, Ms. JENKINS 
of Kansas, Mr. COLLINS of New York, Mr. STIVERS, Mrs. MCMORRIS 
RODGERS, Mr. COSTELLO of Pennsylvania, Mr. FLORES, Mr. ROSKAM, 
Mr. KINZINGER, Mr. SHUSTER, Mr. TIBERI, Mr. WILSON of South Caro-
lina, Mr. SIMPSON, and Mr. MURPHY of Pennsylvania) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Education and the Work-
force, and Ways and Means, 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 concerned 
A BILL 
To amend the Public Health Service Act to prohibit applica-
tion of pre-existing condition exclusions and to guarantee 
availability of health insurance coverage in the individual 
and group market, contingent on the enactment of legis-
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lation repealing the Patient Protection and Affordable 
Care Act, and for other purposes. 
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 ‘‘Pre-existing Conditions 
Protection Act of 2017’’. 
SEC. 2. PROHIBITION OF PRE-EXISTING CONDITION EXCLU-
SIONS. 
(a) GROUP MARKET.—Subject to section 6(a) of this 
Act, subpart 1 of part A of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.), as restored 
or revived pursuant to PPACA repeal legislation described 
in section 6(b) of this Act, is amended by striking section 
2701 and inserting the following: 
‘‘SEC. 2701. PROHIBITION OF PRE-EXISTING CONDITION EX-
CLUSIONS. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group health insurance coverage 
may not impose any pre-existing condition exclusion with 
respect to such plan or coverage. 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) PRE-EXISTING CONDITION EXCLUSION.— 
‘‘(A) IN GENERAL.—The term ‘pre-existing 
condition exclusion’ means, with respect to a 
group health plan or health insurance coverage, 
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a limitation or exclusion of benefits relating to 
a condition based on the fact that the condition 
was present before the date of enrollment in 
such plan or for such coverage, whether or not 
any medical advice, diagnosis, care, or treat-
ment was recommended or received before such 
date. 
‘‘(B) TREATMENT OF GENETIC INFORMA-
TION.—Genetic information shall not be treated 
as a pre-existing condition in the absence of a 
diagnosis of the condition related to such infor-
mation. 
‘‘(2) DATE OF ENROLLMENT.—The term ‘date 
of enrollment’ means, with respect to an individual 
covered under a group health plan or health insur-
ance coverage, the date of enrollment of the indi-
vidual in the plan or coverage or, if earlier, the first 
day of the waiting period for such enrollment. 
‘‘(3) WAITING PERIOD.—The term ‘waiting pe-
riod’ means, with respect to a group health plan and 
an individual who is a potential participant or bene-
ficiary in the plan, the period that must pass with 
respect to the individual before the individual is eli-
gible to be covered for benefits under the terms of 
the plan.’’. 
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(b) INDIVIDUAL MARKET.—Subject to section 6(a) of 
this Act, subpart 1 of part B of title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg–41 et seq.), as re-
stored or revived pursuant to PPACA repeal legislation 
described in section 6(b) of this Act, is amended by adding 
at the end the following: 
‘‘SEC. 2746. PROHIBITION OF PRE-EXISTING CONDITION EX-
CLUSIONS 
OR 
OTHER 
DISCRIMINATION 
BASED ON HEALTH STATUS. 
‘‘The provisions of section 2701 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. 3. GUARANTEED AVAILABILITY OF COVERAGE. 
(a) GROUP MARKET.—Subject to section 6(a) of this 
Act, subpart 3 of part A of title XXVII of the Public 
Health Service Act, as restored or revived pursuant to 
PPACA repeal legislation described in section 6(b) of this 
Act, is amended by striking section 2711 (42 U.S.C. 
300gg–11) and inserting the following: 
‘‘SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE. 
‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE 
GROUP MARKET.—Subject to subsection (b), each health 
insurance issuer that offers health insurance coverage in 
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the group market in a State shall accept every employer 
and every individual in a group in the State that applies 
for such coverage. 
‘‘(b) ENROLLMENT.— 
‘‘(1) RESTRICTION.—A health insurance issuer 
described in subsection (a) may restrict enrollment 
in coverage described in such subsection to open or 
special enrollment periods. 
‘‘(2) ESTABLISHMENT.—A health insurance 
issuer described in subsection (a) shall establish spe-
cial enrollment periods for qualifying events (as such 
term is defined in section 603 of the Employee Re-
tirement Income Security Act of 1974).’’. 
(b) INDIVIDUAL MARKET.—Subject to section 6(a) of 
this Act, subpart 1 of part B of title XXVII of the Public 
Health Service Act, as restored or revived pursuant to 
PPACA repeal legislation described in section 6(b) of this 
Act, is amended by striking section 2741 of such Act (42 
U.S.C. 300gg–41) and inserting the following: 
‘‘SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE. 
‘‘The provisions of section 2711 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 such provisions apply to health insurance coverage 
offered to employers by a health insurance issuer in con-
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nection with health insurance coverage in the group mar-
ket. For purposes of this section, the Secretary shall treat 
any reference of the word ‘employer’ in such section as 
a reference to the term ‘individual’.’’. 
SEC. 4. PROHIBITING DISCRIMINATION AGAINST INDI-
VIDUAL PARTICIPANTS AND BENEFICIARIES 
BASED ON HEALTH STATUS. 
(a) GROUP MARKET.—Subject to section 6(a) of this 
Act, section 2702 of the Public Health Service Act, as re-
stored or revived pursuant to PPACA repeal legislation 
described in section 6(b) of this Act, is amended to read 
as follows: 
‘‘SEC. 2702. PROHIBITING DISCRIMINATION AGAINST INDI-
VIDUAL PARTICIPANTS AND BENEFICIARIES 
BASED ON HEALTH STATUS. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group health insurance coverage 
may not establish rules for eligibility (including continued 
eligibility) of any individual to enroll under the terms of 
the plan or coverage based on any of the following health 
status-related factors in relation to the individual or a de-
pendent of the individual: 
‘‘(1) Health status. 
‘‘(2) Medical condition (including both physical 
and mental illnesses). 
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‘‘(3) Claims experience. 
‘‘(4) Receipt of health care. 
‘‘(5) Medical history. 
‘‘(6) Genetic information. 
‘‘(7) Evidence of insurability (including condi-
tions arising out of acts of domestic violence). 
‘‘(8) Disability. 
‘‘(9) Any other health status-related factor de-
termined appropriate by the Secretary. 
‘‘(b) IN PREMIUM CONTRIBUTIONS.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, may not require any individual (as a 
condition of enrollment or continued enrollment 
under the plan) to pay a premium or contribution 
which is greater than such premium or contribution 
for a similarly situated individual enrolled in the 
plan on the basis of any health status-related factor 
in relation to the individual or to an individual en-
rolled under the plan as a dependent of the indi-
vidual. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall be construed— 
‘‘(A) to restrict the amount that an em-
ployer or individual may be charged for cov-
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erage under a group health plan except as pro-
vided in paragraph (3); or 
‘‘(B) to prevent a group health plan, and 
a health insurance issuer offering group health 
insurance coverage, from establishing premium 
discounts or rebates or modifying otherwise ap-
plicable copayments or deductibles in return for 
adherence to programs of health promotion and 
disease prevention. 
‘‘(3) NO
GROUP-BASED
DISCRIMINATION
ON 
BASIS OF GENETIC INFORMATION.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, a group health plan, and health insur-
ance issuer offering group health insurance cov-
erage, may not adjust premium or contribution 
amounts for the group covered under such plan 
on the basis of genetic information. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in subparagraph (A) or in paragraphs (1) and 
(2) of subsection (d) shall be construed to limit 
the ability of a health insurance issuer offering 
group health insurance coverage to increase the 
premium for an employer based on the mani-
festation of a disease or disorder of an indi-
vidual who is enrolled in the plan. In such case, 
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the manifestation of a disease or disorder in 
one individual cannot also be used as genetic in-
formation about other group members and to 
further increase the premium for the employer. 
‘‘(c) GENETIC TESTING.— 
‘‘(1) LIMITATION ON REQUESTING OR REQUIR-
ING GENETIC TESTING.—A group health plan, and a 
health insurance issuer offering health insurance 
coverage in connection with a group health plan, 
shall not request or require an individual or a family 
member of such individual to undergo a genetic test. 
‘‘(2) RULE OF CONSTRUCTION.—Paragraph (1) 
shall not be construed to limit the authority of a 
health care professional who is providing health care 
services to an individual to request that such indi-
vidual undergo a genetic test. 
‘‘(3) RULE OF CONSTRUCTION REGARDING PAY-
MENT.— 
‘‘(A) IN GENERAL.—Nothing in paragraph 
(1) shall be construed to preclude a group 
health plan, or a health insurance issuer offer-
ing health insurance coverage in connection 
with a group health plan, from obtaining and 
using the results of a genetic test in making a 
determination regarding payment (as such term 
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is defined for the purposes of applying the regu-
lations promulgated by the Secretary under 
part C of title XI of the Social Security Act and 
section 264 of the Health Insurance Portability 
and Accountability Act of 1996, as may be re-
vised from time to time) consistent with sub-
section (a). 
‘‘(B) LIMITATION.—For purposes of sub-
paragraph (A), a group health plan, or a health 
insurance issuer offering health insurance cov-
erage in connection with a group health plan, 
may request only the minimum amount of in-
formation necessary to accomplish the intended 
purpose. 
‘‘(4) RESEARCH EXCEPTION.—Notwithstanding 
paragraph (1), a group health plan, or a health in-
surance issuer offering health insurance coverage in 
connection with a group health plan, may request, 
but not require, that a participant or beneficiary un-
dergo a genetic test if each of the following condi-
tions is met: 
‘‘(A) The request is made pursuant to re-
search that complies with part 46 of title 45, 
Code of Federal Regulations, or equivalent Fed-
eral regulations, and any applicable State or 
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local law or regulations for the protection of 
human subjects in research. 
‘‘(B) The plan or issuer clearly indicates to 
each participant or beneficiary, or in the case of 
a minor child, to the legal guardian of such 
beneficiary, to whom the request is made that— 
‘‘(i) compliance with the request is 
voluntary; and 
‘‘(ii) non-compliance will have no ef-
fect on enrollment status or premium or 
contribution amounts. 
‘‘(C) No genetic information collected or 
acquired under this paragraph shall be used for 
underwriting purposes. 
‘‘(D) The plan or issuer notifies the Sec-
retary in writing that the plan or issuer is con-
ducting activities pursuant to the exception pro-
vided for under this paragraph, including a de-
scription of the activities conducted. 
‘‘(E) The plan or issuer complies with such 
other conditions as the Secretary may by regu-
lation require for activities conducted under this 
paragraph. 
‘‘(d) PROHIBITION ON COLLECTION OF GENETIC IN-
FORMATION.— 
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‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering health insurance 
coverage in connection with a group health plan, 
shall not request, require, or purchase genetic infor-
mation for underwriting purposes (as defined in sec-
tion 2791). 
‘‘(2) PROHIBITION
ON
COLLECTION
OF
GE-
NETIC
INFORMATION
PRIOR
TO
ENROLLMENT.—A 
group health plan, and a health insurance issuer of-
fering health insurance coverage in connection with 
a group health plan, shall not request, require, or 
purchase genetic information with respect to any in-
dividual prior to such individual’s enrollment under 
the plan or coverage in connection with such enroll-
ment. 
‘‘(3) INCIDENTAL
COLLECTION.—If a group 
health plan, or a health insurance issuer offering 
health insurance coverage in connection with a group 
health plan, obtains genetic information incidental to 
the requesting, requiring, or purchasing of other in-
formation concerning any individual, such request, 
requirement, or purchase shall not be considered a 
violation of paragraph (2) if such request, require-
ment, or purchase is not in violation of paragraph 
(1). 
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‘‘(e) GENETIC INFORMATION OF A FETUS OR EM-
BRYO.—Any reference in this part to genetic information 
concerning an individual or family member of an indi-
vidual shall— 
‘‘(1) with respect to such an individual or fam-
ily member of an individual who is a pregnant 
woman, include genetic information of any fetus car-
ried by such pregnant woman; and 
‘‘(2) with respect to an individual or family 
member utilizing an assisted reproductive tech-
nology, include genetic information of any embryo le-
gally held by the individual or family member. 
‘‘(f) PROGRAMS OF HEALTH PROMOTION OR DIS-
EASE PREVENTION.— 
‘‘(1) GENERAL PROVISIONS.— 
‘‘(A) GENERAL
RULE.—For purposes of 
subsection (b)(2)(B), a program of health pro-
motion or disease prevention (referred to in this 
subsection as a ‘wellness program’) shall be a 
program offered by an employer that is de-
signed to promote health or prevent disease 
that meets the applicable requirements of this 
subsection. 
‘‘(B) NO CONDITIONS BASED ON HEALTH 
STATUS FACTOR.—If none of the conditions for 
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obtaining a premium discount or rebate or 
other reward for participation in a wellness pro-
gram is based on an individual satisfying a 
standard that is related to a health status fac-
tor, such wellness program shall not violate this 
section if participation in the program is made 
available to all similarly situated individuals 
and the requirements of paragraph (2) are com-
plied with. 
‘‘(C) CONDITIONS BASED ON HEALTH STA-
TUS FACTOR.—If any of the conditions for ob-
taining a premium discount or rebate or other 
reward for participation in a wellness program 
is based on an individual satisfying a standard 
that is related to a health status factor, such 
wellness program shall not violate this section if 
the requirements of paragraph (3) are complied 
with. 
‘‘(2) WELLNESS PROGRAMS NOT SUBJECT TO 
REQUIREMENTS.—If none of the conditions for ob-
taining a premium discount or rebate or other re-
ward under a wellness program as described in para-
graph (1)(B) are based on an individual satisfying 
a standard that is related to a health status factor 
(or if such a wellness program does not provide such 
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a reward), the wellness program shall not violate 
this section if participation in the program is made 
available to all similarly situated individuals. The 
following programs shall not have to comply with the 
requirements of paragraph (3) if participation in the 
program is made available to all similarly situated 
individuals: 
‘‘(A) A program that reimburses all or 
part of the cost for memberships in a fitness 
center. 
‘‘(B) A diagnostic testing program that 
provides a reward for participation and does 
not base any part of the reward on outcomes. 
‘‘(C) A program that encourages preven-
tive care related to a health condition through 
the waiver of the copayment or deductible re-
quirement under group health plan for the costs 
of certain items or services related to a health 
condition (such as prenatal care or well-baby 
visits). 
‘‘(D) A program that reimburses individ-
uals for the costs of smoking cessation pro-
grams without regard to whether the individual 
quits smoking. 
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‘‘(E) A program that provides a reward to 
individuals for attending a periodic health edu-
cation seminar. 
‘‘(3) WELLNESS
PROGRAMS
SUBJECT
TO
RE-
QUIREMENTS.—If any of the conditions for obtaining 
a premium discount, rebate, or reward under a 
wellness program as described in paragraph (1)(C) 
is based on an individual satisfying a standard that 
is related to a health status factor, the wellness pro-
gram shall not violate this section if the following re-
quirements are complied with: 
‘‘(A) The reward for the wellness program, 
together with the reward for other wellness pro-
grams with respect to the plan that requires 
satisfaction of a standard related to a health 
status factor, shall not exceed 30 percent of the 
cost of employee-only coverage under the plan. 
If, in addition to employees or individuals, any 
class of dependents (such as spouses or spouses 
and dependent children) may participate fully 
in the wellness program, such reward shall not 
exceed 30 percent of the cost of the coverage in 
which an employee or individual and any de-
pendents are enrolled. For purposes of this 
paragraph, the cost of coverage shall be deter-
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mined based on the total amount of employer 
and employee contributions for the benefit 
package under which the employee is (or the 
employee and any dependents are) receiving 
coverage. A reward may be in the form of a dis-
count or rebate of a premium or contribution, 
a waiver of all or part of a cost-sharing mecha-
nism (such as deductibles, copayments, or coin-
surance), the absence of a surcharge, or the 
value of a benefit that would otherwise not be 
provided under the plan. The Secretaries of 
Labor, Health and Human Services, and the 
Treasury may increase the reward available 
under this subparagraph to up to 50 percent of 
the cost of coverage if the Secretaries determine 
that such an increase is appropriate. 
‘‘(B) The wellness program shall be rea-
sonably designed to promote health or prevent 
disease. A program complies with the preceding 
sentence if the program has a reasonable 
chance of improving the health of, or preventing 
disease in, participating individuals and it is 
not overly burdensome, is not a subterfuge for 
discriminating based on a health status factor, 
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and is not highly suspect in the method chosen 
to promote health or prevent disease. 
‘‘(C) The plan shall give individuals eligible 
for the program the opportunity to qualify for 
the reward under the program at least once 
each year. 
‘‘(D) The full reward under the wellness 
program shall be made available to all similarly 
situated individuals. For such purpose, among 
other things: 
‘‘(i) The reward is not available to all 
similarly situated individuals for a period 
unless the wellness program allows— 
‘‘(I) for a reasonable alternative 
standard (or waiver of the otherwise 
applicable standard) for obtaining the 
reward for any individual for whom, 
for that period, it is unreasonably dif-
ficult due to a medical condition to 
satisfy the otherwise applicable stand-
ard; and 
‘‘(II) for a reasonable alternative 
standard (or waiver of the otherwise 
applicable standard) for obtaining the 
reward for any individual for whom, 
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