105TH CONGRESS
1ST SESSION
H. R. 2874
To provide for prompt disclosure to insured individuals of their medical
condition after undergoing medical examinations necessary to qualify
for insurance coverage.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 7, 1997
Mr. ACKERMAN (for himself, Mr. COBURN, Mr. ABERCROMBIE, Mr. BART-
LETT of Maryland, Mr. BECERRA, Mr. BISHOP, Mr. BONO, Mr. BROWN
of Ohio, Mr. BURTON of Indiana, Mr. CLYBURN, Mr. COOK, Mr.
CRAMER, Mr. DEFAZIO, Mr. DELLUMS, Mr. DEUTSCH, Ms. ESHOO, Mr.
FARR of California, Mr. FAZIO of California, Mr. FOGLIETTA, Mr. FORD,
Mr. FRANK of Massachusetts, Mr. FROST, Mr. GRAHAM, Mr. GREEN, Mr.
GUTIERREZ, Mr. HEFNER, Mr. HINCHEY, Mr. HOYER, Mr. JEFFERSON,
Ms. EDDIE BERNICE JOHNSON of Texas, Ms. KAPTUR, Mrs. KELLY, Mr.
KENNEDY of Rhode Island, Ms. KILPATRICK, Mr. KIND, Mr. KUCINICH,
Mr. LAFALCE, Mr. LAMPSON, Mr. LAZIO of New York, Mr. LEWIS of
Georgia, Mrs. LOWEY, Mrs. MCCARTHY of New York, Ms. MCKINNEY,
Mr. MCNULTY, Mrs. MEEK of Florida, Mr. MENENDEZ, Mr. MILLER of
California, Mr. NADLER, Mr. ORTIZ, Mr. OWENS, Mr. PALLONE, Mr.
PAXON, Ms. RIVERS, Mr. RODRIGUEZ, Ms. ROS-LEHTINEN, Mr. ROTH-
MAN, Mr. SANDERS, Mr. SAWYER, Mr. SCHUMER, Mr. SERRANO, Mr.
SHERMAN, Ms. SLAUGHTER, Mr. TANNER, Mr. TAYLOR of Mississippi,
Mr. THOMPSON, Mr. TURNER, Ms. VELA´ZQUEZ, Mr. WALSH, Mr. WAX-
MAN, and Mr. WEXLER) introduced the following bill; which was referred
to the Committee on Commerce, and in addition to the Committee on
Education and the Workforce, 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 provide for prompt disclosure to insured individuals of
their medical condition after undergoing medical exami-
nations necessary to qualify for insurance coverage.
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 ‘‘Insurance Disclosure
Act of 1997’’.
SEC. 2. DEFINITIONS.
As used in this Act:
(1) INSURER.—The term ‘‘insurer’’ means any
person, reciprocal exchange, interinsurer, Lloyds in-
surer, fraternal benefit society, or other legal entity
engaged in the business of insurance, including
agents, brokers, adjusters, and third party adminis-
trators. The term also includes health benefit plans,
health carriers, and life, disability, and property and
casualty insurers.
(2) 
HEALTH
BENEFIT
PLAN.—The 
term
‘‘health benefit plan’’ means any public or private
entity or program that provides for payments for
health care, including—
(A) a group health plan (as defined in sec-
tion 2791(a)(1) of the Public Health Service
Act 
(42 
U.S.C. 
300gg–91(a)(1)), 
section
733(a)(1) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(a)(1)),
or section 5000(b)(1) of the Internal Revenue
Code of 1986));
(B) a multiple employer welfare arrange-
ment (as defined in section 3(40) of the Em-
ployee Retirement Income Security Act (29
U.S.C. 1002(40))) that provides benefits con-
sisting of medical care (as defined in section
733(a)(2) 
of 
such 
Act 
(29 
U.S.C.
1191b(a)(2))), including items and services paid
for as medical care;
(C) any other health insurance arrange-
ment, including any arrangement consisting of
a hospital or medical expense incurred policy or
certificate, hospital or medical service plan con-
tract, or health maintenance organization sub-
scriber contract;
(D) workers’ compensation or similar in-
surance to the extent that it relates to workers’
compensation medical benefits (as defined in
regulations of the Secretary);
(E) automobile medical insurance to the
extent that it relates to medical benefits (as de-
fined in regulations of the Secretary); and
(F) any other insurance providing for en-
rollees medical benefits (as defined in regula-
tions of the Secretary) in the event of sickness,
accident, disability, death, or unemployment.
(3) HEALTH CARRIER.—The term ‘‘health car-
rier’’ means a person that contracts or offers to con-
tract on a risk-assuming basis to provide, deliver, ar-
range for, pay for, or reimburse any of the cost of
health care services, including a sickness and acci-
dent insurance company, a health maintenance orga-
nization, a nonprofit hospital and health service cor-
poration, or any other entity providing a plan of
health insurance, health benefits, or health services.
(4) POLICY.—The term ‘‘policy’’ means a con-
tract of insurance, certificate, indemnity, suretyship,
or annuity issued, proposed for issuance, or intended
for issuance by an insurer, including endorsements
or riders to an insurance policy or contract.
(5) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
SEC. 3. ACCESS BY EXAMINED INDIVIDUAL TO RESULTS OF
MEDICAL EXAMINATIONS.
An insurer shall take such actions as are necessary
to ensure that, in any case in which—
(1) a medical examination of an individual is
required for initial or continued enrollment under a
policy issued by the insurer, and
(2) such medical examination is conducted by a
person who is in the employ of the insurer or whose
services are procured otherwise by the insurer,
such individual (or the individual’s legal guardian) is pro-
vided all medical information obtained from such examina-
tion at the same time that such information is made avail-
able to the insurer and is encouraged to make such infor-
mation available to such individual’s own physician.
SEC. 4. ENFORCEMENT.
(a) APPLICABILITY OF CERTAIN PUBLIC HEALTH
SERVICE ACT PROVISIONS.—
(1) IN
GENERAL.—For purposes of sections
2722 and 2723 of the Public Health Service Act (42
U.S.C. 300gg–22, 300gg–23), the provisions of sec-
tion 3 shall be deemed provisions of part A of title
XXVII of such Act. For purposes of sections 2761
and 2762 of such Act (42 U.S.C. 300gg–45, 300gg–
46), the provisions of section 3 shall be deemed pro-
visions of part B of such title XXVII.
(2) RULES
OF
CONSTRUCTION.—In applying
such sections 2722, 2723, 2761 and 2762, and sec-
tion 2791(d) of such Act (42 U.S.C. 300gg–91(d))
pursuant to paragraph (1)—
(A) any reference to a ‘‘health insurance
issuer’’ shall be deemed a reference to an in-
surer (as defined in section 2(1)));
(B) any reference to ‘‘health insurance cov-
erage’’ (including any such coverage offered in
connection with a group health plan) shall be
deemed a reference to a policy (as defined in
section 2(4));
(C) any reference to a ‘‘group health plan’’
shall be deemed a reference to a group insur-
ance plan (as defined in section 111(b)(1) of
the Employee Retirement Income Security Act
of 1974, and subject to the same rules as apply
with respect to group health plans under section
2721(a) of the Public Health Service Act (42
U.S.C. 300gg–21(a))); and
(D) any reference to part A or part B of
title XXVII of such Act shall be deemed a ref-
erence to sections 2 through 6 of this Act.
(b) PRIVATE CAUSE OF ACTION.—
(1) IN GENERAL.—An individual who believes
that he or she has been adversely affected by an act
or practice of an insurer in violation of section 3
may maintain an action against the insurer in a
Federal or State court of original jurisdiction. Upon