(1) IN GENERAL.—A requirement or standard
imposed under this Act on a health plan shall be
deemed to be a requirement or standard imposed on
the health plan issuer. Such requirements or stand-
ards shall be enforced by the State insurance com-
missioner for the State involved or the official or of-
ficials designated by the State to enforce the re-
quirements of this Act. In the case of a health plan
offered by a health plan issuer in connection with an
employee health benefit plan, the requirements or
standards imposed under this Act shall be enforced
with respect to the health plan issuer by the State
insurance commissioner for the State involved or the
official or officials designated by the State to enforce
the requirements of this Act.
(2) LIMITATION.—Except as provided in section
8(c), the Secretary shall not enforce the require-
ments or standards of this Act as they relate to
health plan issuers or health plans. In no case shall
a State enforce the requirements or standards of
this Act as they relate to employee health benefit
plans.
(b) RULE OF CONSTRUCTION.—Nothing in this Act
shall be construed to affect or modify the provisions of
section 514 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1144).
SEC. 8. ENFORCEMENT.
(a) HEALTH PLAN ISSUERS.—Each State shall re-
quire that each health plan issued, sold, renewed, offered
for sale or operated in such State by a health plan issuer
meet the standards established under this Act. A State
shall submit such information as required by the Secretary
demonstrating effective implementation of the require-
ments of this Act.
(b) EMPLOYEE HEALTH BENEFIT PLANS.—With re-
spect to employee health benefit plans, the standards es-
tablished under this Act shall be enforced in the same
manner as provided for under sections 502, 504, 506, and
510 of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1132, 1134, 1136, and 1140). The civil
penalties contained in paragraphs (1) and (2) of section
502(c) of such Act (29 U.S.C. 1132(c) (1) and (2)) shall
apply to any information required by the Secretary to be
disclosed and reported under this section.
(c) FAILURE TO ENFORCE.—In the case of the fail-
ure of a State to substantially enforce the standards and
requirements set forth in this Act with respect to health
plans, the Secretary, in consultation with the Secretary
of Health and Human Services, shall enforce the stand-
ards of this Act in such State. In the case of a State that
fails to substantially enforce the standards set forth in this
Act, each health plan issuer operating in such State shall
be subject to civil enforcement as provided for under sec-
tions 502, 504, 506, and 510 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1132, 1134,
1136, and 1140). The civil penalties contained in para-
graphs (1) and (2) of section 502(c) of such Act (29
U.S.C. 1132(c) (1) and (2)) shall apply to any information
required by the Secretary to be disclosed and reported
under this section.
(d) REGULATIONS.—The Secretary, in consultation
with the Secretary of Health and Human Services, may
promulgate such regulations as may be necessary or ap-
propriate to carry out this Act.
SEC. 9. DEFINITIONS.
As used in this Act:
(1) ATTENDING PROVIDER.—The term ‘‘attend-
ing provider’’ shall include the obstetrician-gyne-
cologists, pediatrician, family physician, or other
physician attending the mother or newly born child.
Such term shall also include any other health care
provider who, in accordance with applicable State
law, may be primarily responsible for the care of a
mother and her newborn child (including nurse mid-
wives and nurse practitioners).
(2) BENEFICIARY.—The term ‘‘beneficiary’’ has
the meaning given such term under section 3(8) of
the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1002(8)).
(3) EMPLOYEE HEALTH BENEFIT PLAN.—
(A) IN
GENERAL.—The term ‘‘employee
health benefit plan’’ means any employee wel-
fare benefit plan, governmental plan, or church
plan (as defined under paragraphs (1), (32),
and (33) of section 3 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C.
1002 (1), (32), and (33))) that provides or pays
for health benefits (such as provider and hos-
pital benefits) for participants and beneficiaries
whether—
(i) directly;
(ii) through a health plan offered by
a health plan issuer as defined in para-
graph (4); or
(iii) otherwise.
(B) RULE
OF
CONSTRUCTION.—An em-
ployee health benefit plan shall not be con-
strued to be a health plan or a health plan is-
suer.
(C) ARRANGEMENTS
NOT
INCLUDED.—
Such term does not include the following, or
any combination thereof:
(i) Coverage only for accident, or dis-
ability income insurance, or any combina-
tion thereof.
(ii) Medicare supplemental health in-
surance 
(as 
defined 
under 
section
1882(g)(1) of the Social Security Act).
(iii) Coverage issued as a supplement
to liability insurance.
(iv) Liability insurance, including gen-
eral liability insurance and automobile li-
ability insurance.
(v) Workers compensation or similar
insurance.
(vi) Automobile medical payment in-
surance.
(vii) Coverage for a specified disease
or illness.
(viii) Hospital or fixed indemnity in-
surance.