issuer, such plan or issuer shall ensure that coverage 
is provided with respect to the services necessary for 
the secondary consultation with any other specialist 
selected by the attending physician for such purpose 
at no additional cost to the individual beyond that 
which the individual would have paid if the specialist 
was participating in the network of the plan. 
‘‘(2) EXCEPTION.—Nothing in paragraph (1) 
shall be construed as requiring the provision of sec-
ondary consultations where the patient determines not 
to seek such a consultation. 
‘‘(e) PROHIBITION ON PENALTIES.—A group health 
plan may not— 
‘‘(1) penalize or otherwise reduce or limit the re-
imbursement of a provider or specialist because the 
provider or specialist provided care to a participant 
or beneficiary in accordance with this section; 
‘‘(2) provide financial or other incentives to a 
physician or specialist to induce the physician or spe-
cialist to keep the length of inpatient stays of patients 
following a mastectomy, lumpectomy, or a lymph 
node dissection for the treatment of breast cancer 
below certain limits or to limit referrals for secondary 
consultations; 
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‘‘(3) provide financial or other incentives to a 
physician or specialist to induce the physician or spe-
cialist to refrain from referring a participant or bene-
ficiary for a secondary consultation that would other-
wise be covered by the plan involved under subsection 
(d); or 
‘‘(4) deny to a woman eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan solely for the purpose of avoiding 
the requirements of this section.’’. 
(b) CLERICAL AMENDMENT.—The table of contents for 
chapter 100 of such Code is amended by inserting after the 
item relating to section 9812 the following: 
‘‘Sec. 9813. Required coverage for minimum hospital stay for mastectomies, 
lumpectomies, and lymph node dissections for the treatment of 
breast cancer and coverage for secondary consultations.’’. 
(c) EFFECTIVE DATES.— 
(1) IN
GENERAL.—The amendments made by 
this section shall apply with respect to plan years be-
ginning on or after the date of enactment of this Act. 
(2) SPECIAL RULE FOR COLLECTIVE BARGAINING 
AGREEMENTS.—In the case of a group health plan 
maintained pursuant to 1 or more collective bar-
gaining agreements between employee representatives 
and 1 or more employers ratified before the date of 
enactment of this Act, the amendments made by this 
section shall not apply to plan years beginning before 
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the date on which the last collective bargaining agree-
ments relating to the plan terminates (determined 
without regard to any extension thereof agreed to 
after the date of enactment of this Act). For purposes 
of this paragraph, any plan amendment made pursu-
ant to a collective bargaining agreement relating to 
the plan which amends the plan solely to conform to 
any requirement added by this section shall not be 
treated as a termination of such collective bargaining 
agreement. 
SEC. 7. OPPORTUNITY FOR INDEPENDENT, EXTERNAL 
THIRD PARTY REVIEWS OF CERTAIN NON-
RENEWALS 
AND 
DISCONTINUATIONS, 
IN-
CLUDING 
RESCISSIONS, 
OF 
INDIVIDUAL 
HEALTH INSURANCE COVERAGE. 
(a) CLARIFICATION
REGARDING
APPLICATION
OF 
GUARANTEED RENEWABILITY OF INDIVIDUAL HEALTH IN-
SURANCE COVERAGE.—Section 2742 of the Public Health 
Service Act (42 U.S.C. 300gg–42) is amended— 
(1) in its heading, by inserting ‘‘, CONTINU-
ATION IN FORCE, INCLUDING PROHIBITION OF 
RESCISSION,’’ 
after 
‘‘GUARANTEED
RENEW-
ABILITY’’; 
(2) in subsection (a), by inserting ‘‘, including 
without rescission,’’ after ‘‘continue in force’’; and 
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(3) in subsection (b)(2), by inserting before the 
period at the end the following: ‘‘, including inten-
tional concealment of material facts regarding a 
health condition related to the condition for which 
coverage is being claimed’’. 
(b) OPPORTUNITY
FOR
INDEPENDENT, EXTERNAL 
THIRD PARTY REVIEW IN CERTAIN CASES.—Subpart 1 of 
part B of title XXVII of the Public Health Service Act is 
amended by adding at the end the following new section: 
‘‘SEC. 2746. OPPORTUNITY FOR INDEPENDENT, EXTERNAL 
THIRD PARTY REVIEW IN CERTAIN CASES. 
‘‘(a) NOTICE AND REVIEW RIGHT.—If a health insur-
ance issuer determines to nonrenew or not continue in force, 
including rescind, health insurance coverage for an indi-
vidual in the individual market on the basis described in 
section 2742(b)(2) before such nonrenewal, discontinuation, 
or rescission, may take effect the issuer shall provide the 
individual with notice of such proposed nonrenewal, dis-
continuation, or rescission and an opportunity for a review 
of such determination by an independent, external third 
party under procedures specified by the Secretary. 
‘‘(b) INDEPENDENT DETERMINATION.—If the indi-
vidual requests such review by an independent, external 
third party of a nonrenewal, discontinuation, or rescission 
of health insurance coverage, the coverage shall remain in 
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effect until such third party determines that the coverage 
may be nonrenewed, discontinued, or rescinded under sec-
tion 2742(b)(2).’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply after the date of the enactment of this 
Act with respect to health insurance coverage issued before, 
on, or after such date. 
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Union Calendar No. 564 
110TH CONGRESS 
2D SESSION 
H. R. 758 
[Report No. 110–868, Part I] 
A BILL 
To require that health plans provide coverage for a 
minimum 
hospital 
stay 
for 
mastectomies, 
lumpectomies, and lymph node dissection for the 
treatment of breast cancer and coverage for sec-
ondary consultations. 
SEPTEMBER 23, 2008 
Committees on Ways and Means and Education and 
Labor discharged; committed to the Committee of the 
Whole House on the State of the Union and ordered 
to be printed 
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