I 
111TH CONGRESS 
1ST SESSION H. R. 1085 
To impose a limitation on lifetime aggregate limits imposed by health plans. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 13, 2009 
Ms. ESHOO (for herself, Mr. ALTMIRE, Mr. LANGEVIN, Ms. SUTTON, and Mr. 
KILDEE) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, 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 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. SHORT TITLE. 
This Act may be cited as the ‘‘Health Insurance Cov-
erage Protection Act’’. 
SEC. 2. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974. 
(a) IN GENERAL.—Subpart B of part 7 of subtitle 
B of title I of the Employee Retirement Income Security 
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Act of 1974 (29 U.S.C. 1185 et seq.) is amended by add-
ing at the end the following: 
‘‘SEC. 715. 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 2 plan years after 
the effective date of this section, $5,000,000; 
‘‘(2) with respect to the third and fourth plan 
years after such date, $10,000,000; and 
‘‘(3) with respect to each subsequent year, the 
amount for the previous year adjusted by the per-
centage increase in the consumer price index (for all 
urban consumers) for such year; 
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, except that upon the request of 
such a small employer, the plan involved shall pro-
vide for the application of an aggregate dollar life-
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time limit that is consistent with the limit required 
under such subsection. 
‘‘(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 pre-
ceding 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 
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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, is amended by inserting after 
the item relating to section 714 the following new item: 
‘‘Sec. 715. 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 1 year after the date 
of enactment of this Act. 
SEC. 3. AMENDMENT 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 (42 U.S.C. 
300gg–4 et seq.) is amended by adding at the end the 
following: 
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‘‘SEC. 2708. 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 2 plan years after 
the effective date of this section, $5,000,000; 
‘‘(2) with respect to the third and fourth plan 
years after such date, $10,000,000; and 
‘‘(3) with respect to each subsequent year, the 
amount for the previous year adjusted by the per-
centage increase in the consumer price index (for all 
urban consumers) for such year; 
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, except that upon the request of 
such a small employer, the plan involved shall pro-
vide for the application of an aggregate dollar life-
time limit that is consistent with the limit required 
under such subsection. 
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‘‘(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 pre-
ceding 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. 
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‘‘(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 1 year after the date 
of enactment of this Act. 
SEC. 4. STUDY BY THE INSTITUTE OF MEDICINE. 
The Secretary of Health and Human Services shall 
enter into a contract with the Institute of Medicine for 
the conduct of a study to determine the number of individ-
uals who have reached the lifetime limitations set forth 
in the amendments made by this Act beginning in the 
third plan year for which such amendments apply. Not 
later than 1 year after the date on which the study is con-
ducted under the previous sentence, the Institute of Medi-
cine shall submit to the Secretary and the appropriate 
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committees of Congress a report concerning the results of 
the study. 
Æ 
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