I 
111TH CONGRESS 
1ST SESSION H. R. 3472 
To provide for health insurance coverage premium discounts for healthy 
behavior and improvements toward healthy behavior. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2009 
Mrs. DAHLKEMPER introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means and Education and Labor, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To provide for health insurance coverage premium discounts 
for healthy behavior and improvements toward healthy 
behavior. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. PREMIUM DISCOUNTS FOR HEALTHY LIVING. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, for plan years beginning on or after January 
1, 2010, a group health plan, and a health insurance 
issuer offering group health insurance coverage in the 
group market or health insurance coverage in the indi-
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vidual market, shall provide premium discounts for 
healthy behavior and improvements toward healthy behav-
ior as determined under this section. 
(b) DETERMINATION OF PREMIUM DISCOUNTS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Pre-
vention, shall conclude a rulemaking procedure to 
determine the appropriate premium discount appli-
cable to each healthy behavior and each improve-
ment toward healthy behavior. Such discounts shall 
be consistent with the regulations applicable to 
wellness programs issued under the Health Insur-
ance Portability and Accountability Act of 1996. 
(2) LIMITATION.—Such discounts shall not, in 
the aggregate, exceed 20 percent with respect to any 
individual. 
(c) HEALTHY BEHAVIOR.—For purposes of this sec-
tion, the following are healthy behaviors: 
(1) Not smoking. 
(2) Low blood pressure (but within the normal 
range). 
(3) Body mass index (BMI) in the normal 
range. 
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(4) Low low-density lipoprotein (LDL) levels. 
(5) High high-density lipoprotein (HDL) levels. 
(6) Appropriate hemoglobin AIC levels. 
(d) IMPROVEMENTS TOWARDS HEALTHY BEHAV-
IOR.—For purposes of this section, the following are im-
provements towards healthy behavior: 
(1) Quitting smoking. 
(2) Reducing blood pressure, but not below the 
normal range. 
(3) Lowering body mass index (BMI), but not 
below the normal range. 
(4) Lowering low-density lipoprotein (LDL) lev-
els. 
(5) Increasing high-density lipoprotein (HDL) 
levels. 
(6) Lowering hemoglobin AIC levels, but not 
below the normal range. 
(e) CERTIFICATION.—In order to be taken into ac-
count under this section, any healthy behavior or improve-
ment towards healthy behavior must be supported by med-
ical test result information which is certified by a licensed 
physician, and the individual to whom it relates, as being 
complete, accurate and current. In the case of any know-
ingly false certification under this subsection, the Sec-
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retary of Health and Human Services shall impose a civil 
monetary penalty not in excess of $1,000. 
(f) APPLICATION TO ERISA, PHSA, AND IRC.—The 
provisions of this section shall apply with respect to a 
group health plan as if included under title XXVII of the 
Public Health Service Act, under title VII of the Employee 
Retirement Income Security Act of 1974, and under sub-
chapter B of chapter 100 of the Internal Revenue Code 
of 1986, and shall apply with respect to health insurance 
coverage offered in the individual market as if included 
under title XXVII of the Public Health Service Act. 
Æ 
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