I 
112TH CONGRESS 
2D SESSION 
H. R. 4242 
To repeal the Patient Protection and Affordable Care Act, to amend the 
Public Health Service Act to provide individual and group market re-
forms to protect health insurance consumers, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 22, 2012 
Mr. HECK introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committees on Ways 
and Means, Education and the Workforce, the Judiciary, Natural Re-
sources, Rules, House Administration, and Appropriations, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To repeal the Patient Protection and Affordable Care Act, 
to amend the Public Health Service Act to provide indi-
vidual and group market reforms to protect health insur-
ance consumers, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Ensuring Quality Health Care for All Americans Act of 
2012’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Repeal of PPACA. 
Sec. 3. Prohibiting discrimination based on health status. 
Sec. 4. Guaranteed renewability of coverage. 
Sec. 5. Prohibition of preexisting condition exclusions and other discrimination 
based on health status. 
Sec. 6. No lifetime or annual limits. 
Sec. 7. Prohibition on rescissions. 
Sec. 8. Extension of dependent coverage. 
Sec. 9. Application of group market reforms to ERISA and the Internal Rev-
enue Code of 1986. 
Sec. 10. Catastrophic plan. 
Sec. 11. Grants for health insurance risk adjustment mechanisms. 
Sec. 12. Liability protections for health care providers. 
SEC. 2. REPEAL OF PPACA. 
(a) PPACA.—Public Law 111–148 is repealed, and 
the provisions of law amended or repealed by such Act 
are restored or revived as if such Act had not been en-
acted. 
(b) HCERA.—Title I and subtitle B of title II of the 
Health Care and Education Reconciliation Act of 2010 
(Public Law 111–152) are repealed, and the provisions of 
law amended or repealed by such title or subtitle, respec-
tively, are restored or revived as if such title and subtitle 
had not been enacted. 
SEC. 3. PROHIBITING DISCRIMINATION BASED ON HEALTH 
STATUS. 
(a) GROUP MARKET.—Subpart 3 of part A of title 
XXVII of the Public Health Service Act is amended by 
striking section 2711 and inserting the following: 
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‘‘SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE. 
‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE 
GROUP MARKET.— 
‘‘(1) IN GENERAL.—Subject to subsections (b) 
through (e), each health insurance issuer that offers 
health insurance coverage in the group market in a 
State shall accept every employer and every indi-
vidual in a group in the State that applies for such 
coverage. 
‘‘(2) SPECIAL
RULE
FOR
ASSOCIATIONS.—An 
association shall be treated as an employer for pur-
poses of this section if such association seeks to pro-
vide group health insurance coverage to not less 
than 200 qualified individuals. 
‘‘(b) ENROLLMENT.— 
‘‘(1) RESTRICTION.—A health insurance issuer 
described in subsection (a) may restrict enrollment 
in coverage described in such subsection to open or 
special enrollment periods. 
‘‘(2) ESTABLISHMENT.—A health insurance 
issuer described in subsection (a) shall, in accord-
ance with the regulations promulgated under para-
graph (3), establish special enrollment periods for 
qualifying events (as such term is defined in section 
603 of the Employee Retirement Income Security 
Act of 1974). 
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‘‘(3) SPECIAL RULES FOR ASSOCIATIONS.— 
‘‘(A) QUALIFYING EVENTS.—For purposes 
of applying paragraph (2) to an association— 
‘‘(i) the term ‘covered employee’ in 
section 603 of the Employee Retirement 
Income Security Act of 1974 shall include 
a qualified individual (as such term is de-
fined in section 2701(d)(2)(D)); 
‘‘(ii) the term ‘employer’ shall include 
an association (as such term is defined in 
section 2701(d)(2)(A)); and 
‘‘(iii) the term ‘termination (other 
than by reason of such employee’s gross 
misconduct), or reduction of hours, of the 
covered employee’s employment’ shall in-
clude the termination of membership to the 
association. 
‘‘(B) 
ENROLLMENT.—With 
respect 
to 
health insurance coverage provided to an asso-
ciation under subsection (a)(2), a health insur-
ance issuer shall permit a qualified individual 
who is eligible, but not enrolled (or a dependent 
of such individual if the dependent is eligible, 
but not enrolled) for such coverage to enroll for 
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coverage under the terms of such coverage 
when any one of the following events occur: 
‘‘(i) NEW
MEMBERS
AND
EMPLOY-
EES.—A qualified individual, and any de-
pendent of such individual, may enroll dur-
ing the 30-day period following the end of 
the 
period 
described 
under 
section 
2701(d)(2)(D) that applies to such indi-
vidual. 
‘‘(ii) 
ANNUAL
ENROLLMENT.—A 
qualified individual, and any dependent of 
such individual, may enroll during the an-
nual enrollment period established under 
the terms of the coverage 
‘‘(C) TERMINATION
OF
ENROLLMENT.— 
With respect to group health insurance cov-
erage provided by an association, a qualified in-
dividual or dependent who terminates enroll-
ment in such coverage may only re-enroll in 
such coverage during the annual enrollment pe-
riod described under subparagraph (B)(ii). 
‘‘(D) DEFINITIONS.—For purposes of this 
section, the terms ‘association’ and ‘qualified 
individual’ have the meaning given such terms 
in section 2701(d)(2). 
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‘‘(4) REGULATIONS.—The Secretary shall pro-
mulgate regulations with respect to enrollment peri-
ods under this subsection. 
‘‘(c) SPECIAL RULES FOR NETWORK PLANS.— 
‘‘(1) IN GENERAL.—In the case of a health in-
surance issuer that offers health insurance coverage 
in the group market in a State through a network 
plan, the issuer may— 
‘‘(A) limit the employers that may apply 
for such coverage to those with eligible individ-
uals who live, work, or reside in the service area 
for such network plan; and 
‘‘(B) within the service area of such plan, 
deny such coverage to such employers if the 
issuer has demonstrated, if required, to the ap-
plicable State authority that— 
‘‘(i) it will not have the capacity to de-
liver services adequately to enrollees of any 
additional groups because of its obligations 
to existing group contract holders and en-
rollees; and 
‘‘(ii) it is applying this paragraph uni-
formly to all employers without regard 
to— 
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‘‘(I) the claims experience of 
those employers and their employees 
(and their dependents); or 
‘‘(II) any health-status-related 
factor relating to such employees and 
dependents. 
‘‘(2) 180-DAY
SUSPENSION
UPON
DENIAL
OF 
COVERAGE.—An issuer, upon denying health insur-
ance coverage in any service area in accordance with 
paragraph (1)(B), may not offer coverage in the 
group market within such service area for a period 
of 180 days after the date such coverage is denied. 
‘‘(d) APPLICATION OF FINANCIAL CAPACITY LIM-
ITS.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
may deny health insurance coverage in the group if 
the issuer has demonstrated, if required, to the ap-
plicable State authority that— 
‘‘(A) it does not have the financial reserves 
necessary to underwrite additional coverage; 
and 
‘‘(B) it is applying this paragraph uni-
formly to all employers and individuals in the 
group market in the State— 
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‘‘(i) in a manner that is consistent 
with applicable State law; and 
‘‘(ii) without regard to— 
‘‘(I) the claims experience of 
those individuals, employers, and their 
employees (and their dependents); or 
‘‘(II) any health-status-related 
factor relating to such individuals, 
employees, and dependents. 
‘‘(2) 180-DAY
SUSPENSION
UPON
DENIAL
OF 
COVERAGE.—A health insurance issuer upon denying 
health insurance coverage in connection with group 
health plans in accordance with paragraph (1) in a 
State may not offer coverage in connection with 
group health plans in the group market in the State 
for a period of 180 days after the date such cov-
erage is denied or until the issuer has demonstrated 
to the applicable State authority, if required under 
applicable State law, that the issuer has sufficient fi-
nancial reserves to underwrite additional coverage, 
whichever is later. An applicable State authority 
may provide for the application of this subsection on 
a service-area-specific basis.’’. 
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(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act is amended 
by striking section 2741 and inserting the following: 
‘‘SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE. 
‘‘The provisions of section 2711 (other than sub-
section (a)(2) and subsection (b)(3)) shall apply to health 
insurance coverage offered to individuals by a health in-
surance issuer in the individual market in the same man-
ner as such provisions apply to health insurance coverage 
offered to employers by a health insurance issuer in con-
nection with health insurance coverage in the group mar-
ket. For purposes of this section, the Secretary shall treat 
any reference of the word ‘employer’ in such section as 
a reference to the term ‘individual’.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall be effective for plan years beginning on 
or after January 1, 2014. 
SEC. 4. GUARANTEED RENEWABILITY OF COVERAGE. 
(a) GROUP MARKET.—Section 2712 of the Public 
Health Service Act is amended— 
(1) in subsection (a)— 
(A) by inserting ‘‘, including coverage of-
fered’’ before ‘‘in connection with a group 
health plan’’; and 
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(B) by inserting ‘‘employer or other’’ be-
fore ‘‘plan sponsor of the plan’’; 
(2) in subsection (b)— 
(A) in the matter before paragraph (1), by 
striking ‘‘health insurance coverage in connec-
tion with a group health plan in the small or 
large group market’’ and insert ‘‘such health in-
surance coverage’’; and 
(B) in paragraph (6) by striking ‘‘ one or 
more bona fide associations’’ and inserting ‘‘one 
or more associations (as such term is defined in 
section 2701(d)(2)(A))’’; 
(3) in subsection (c)(1)(B), by striking ‘‘to a 
group health plan’’; 
(4) in subsection (d)— 
(A) in matter before paragraph (1), by 
striking ‘‘to a group health plan’’; and 
(B) in paragraph (2), by striking ‘‘bona 
fide associations’’ and inserting ‘‘associations 
(as 
such 
term 
is 
defined 
in 
section 
2701(d)(2)(A))’’; and 
(5) in subsection (e), by inserting ‘‘(as such 
term is defined in section 2701(d)(2)(A))’’ after 
‘‘one or more associations’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
this section shall be effective for plan years beginning on 
or after January 1, 2014. 
SEC. 5. PROHIBITION OF PREEXISTING CONDITION EXCLU-
SIONS AND OTHER DISCRIMINATION BASED 
ON HEALTH STATUS. 
(a) GROUP MARKET.—Subpart 1 of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg) is amended by striking section 2701 and inserting 
the following: 
‘‘SEC. 2701. PROHIBITION OF PREEXISTING CONDITION EX-
CLUSIONS 
AND 
OTHER 
DISCRIMINATION 
BASED ON HEALTH STATUS. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group health insurance coverage 
may not impose any preexisting condition exclusion with 
respect to such plan or coverage. 
‘‘(b) DEFINITIONS.—For purposes of this part: 
‘‘(1) PREEXISTING CONDITION EXCLUSION.— 
‘‘(A) IN GENERAL.—The term ‘preexisting 
condition exclusion’ means, with respect to a 
group health plan or health insurance coverage, 
a limitation or exclusion of benefits relating to 
a condition based on the fact that the condition 
was present before the date of enrollment in 
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such plan or for such coverage, whether or not 
any medical advice, diagnosis, care, or treat-
ment was recommended or received before such 
date. 
‘‘(B) TREATMENT OF GENETIC INFORMA-
TION.—Genetic information shall not be treated 
as a preexisting condition in the absence of a 
diagnosis of the condition related to such infor-
mation. 
‘‘(2) DATE OF ENROLLMENT.—The term ‘date 
of enrollment’ means, with respect to an individual 
covered under a group health plan or health insur-
ance coverage, the date of enrollment of the indi-
vidual in the plan or coverage or, if earlier, the first 
day of the waiting period for such enrollment. 
‘‘(3) WAITING PERIOD.—The term ‘waiting pe-
riod’ means, with respect to a group health plan and 
an individual who is a potential participant or bene-
ficiary in the plan, the period that must pass with 
respect to the individual before the individual is eli-
gible to be covered for benefits under the terms of 
the plan. 
‘‘(c) SPECIAL ENROLLMENT PERIODS.— 
‘‘(1) INDIVIDUALS LOSING OTHER COVERAGE.— 
A group health plan, and a health insurance issuer 
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offering group health insurance coverage in connec-
tion with a group health plan, shall permit an em-
ployee who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of such 
an employee if the dependent is eligible, but not en-
rolled, for coverage under such terms) to enroll for 
coverage under the terms of the plan if each of the 
following conditions is met: 
‘‘(A) The employee or dependent was cov-
ered under a group health plan or had health 
insurance coverage at the time coverage was 
previously offered to the employee or dependent. 
‘‘(B) The employee stated in writing at 
such time that coverage under a group health 
plan or health insurance coverage was the rea-
son for declining enrollment, but only if the 
plan sponsor or issuer (if applicable) required 
such a statement at such time and provided the 
employee with notice of such requirement (and 
the consequences of such requirement) at such 
time. 
‘‘(C) The employee’s or dependent’s cov-
erage described in subparagraph (A)— 
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‘‘(i) was under a COBRA continu-
ation provision and the coverage under 
such provision was exhausted; or 
‘‘(ii) was not under such a provision 
and either the coverage was terminated as 
a result of loss of eligibility for the cov-
erage (including as a result of legal separa-
tion, divorce, death, termination of employ-
ment, or reduction in the number of hours 
of employment) or employer contributions 
toward such coverage were terminated. 
‘‘(D) Under the terms of the plan, the em-
ployee requests such enrollment not later than 
30 days after the date of exhaustion of coverage 
described in subparagraph (C)(i) or termination 
of coverage or employer contribution described 
in subparagraph (C)(ii). 
‘‘(2) FOR DEPENDENT BENEFICIARIES.— 
‘‘(A) IN GENERAL.—If— 
‘‘(i) a group health plan makes cov-
erage available with respect to a dependent 
of an individual; 
‘‘(ii) the individual is a participant 
under the plan (or has met any waiting pe-
riod applicable to becoming a participant 
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under the plan and is eligible to be enrolled 
under the plan but for a failure to enroll 
during a previous enrollment period); and 
‘‘(iii) a person becomes such a de-
pendent of the individual through mar-
riage, birth, or adoption or placement for 
adoption, 
the group health plan shall provide for a de-
pendent special enrollment period described in 
subparagraph (B) during which the person (or, 
if not otherwise enrolled, the individual) may be 
enrolled under the plan as a dependent of the 
individual, and in the case of the birth or adop-
tion of a child, the spouse of the individual may 
be enrolled as a dependent of the individual if 
such spouse is otherwise eligible for coverage. 
‘‘(B) DEPENDENT SPECIAL ENROLLMENT 
PERIOD.—A dependent special enrollment pe-
riod under this subparagraph shall be a period 
of not less than 30 days and shall begin on the 
later of— 
‘‘(i) the date dependent coverage is 
made available; or 
‘‘(ii) the date of the marriage, birth, 
or adoption or placement for adoption (as 
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the case may be) described in subpara-
graph (A)(iii). 
‘‘(C) NO
WAITING
PERIOD.—If an indi-
vidual seeks to enroll a dependent during the 
first 30 days of such a dependent special enroll-
ment period, the coverage of the dependent 
shall become effective— 
‘‘(i) in the case of marriage, not later 
than the first day of the first month begin-
ning after the date the completed request 
for enrollment is received; 
‘‘(ii) in the case of a dependent’s 
birth, as of the date of such birth; or 
‘‘(iii) in the case of a dependent’s 
adoption or placement for adoption, the 
date of such adoption or placement for 
adoption. 
‘‘(3) SPECIAL RULES FOR APPLICATION IN CASE 
OF MEDICAID AND CHIP.— 
‘‘(A) IN GENERAL.—A group health plan, 
and a health insurance issuer offering group 
health insurance coverage in connection with a 
group health plan, shall permit an employee 
who is eligible, but not enrolled, for coverage 
under the terms of the plan (or a dependent of 
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such an employee if the dependent is eligible, 
but not enrolled, for coverage under such 
terms) to enroll for coverage under the terms of 
the plan or coverage if either of the following 
conditions is met: 
‘‘(i) TERMINATION OF MEDICAID OR 
CHIP
COVERAGE.—The employee or de-
pendent is covered under a Medicaid plan 
under title XIX of the Social Security Act 
or under a State child health plan under 
title XXI of such Act and coverage of the 
employee or dependent under such a plan 
is terminated as a result of loss of eligi-
bility for such coverage and the employee 
requests coverage under the group health 
plan (or health insurance coverage) not 
later than 60 days after the date of termi-
nation of such coverage. 
‘‘(ii) ELIGIBILITY FOR EMPLOYMENT 
ASSISTANCE UNDER MEDICAID OR CHIP.— 
The employee or dependent becomes eligi-
ble for assistance, with respect to coverage 
under the group health plan or health in-
surance coverage, under such Medicaid 
plan or State child health plan (including 
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under any waiver or demonstration project 
conducted under or in relation to such a 
plan), if the employee requests coverage 
under the group health plan or health in-
surance coverage not later than 60 days 
after the date the employee or dependent is 
determined to be eligible for such assist-
ance. 
‘‘(B) COORDINATION WITH MEDICAID AND 
CHIP.— 
‘‘(i) OUTREACH TO EMPLOYEES RE-
GARDING AVAILABILITY OF MEDICAID AND 
CHIP COVERAGE.— 
‘‘(I) IN
GENERAL.—Each em-
ployer that maintains a group health 
plan in a State that provides medical 
assistance under a State Medicaid 
plan under title XIX of the Social Se-
curity Act, or child health assistance 
under a State child health plan under 
title XXI of such Act, in the form of 
premium assistance for the purchase 
of coverage under a group health 
plan, shall provide to each employee a 
written notice informing the employee 
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of potential opportunities then cur-
rently available in the State in which 
the employee resides for premium as-
sistance under such plans for health 
coverage of the employee or the em-
ployee’s dependents. For purposes of 
compliance with this subclause, the 
employer may use any State-specific 
model notice developed in accordance 
with section 701(f)(3)(B)(i)(II) of the 
Employee Retirement Income Security 
Act 
of 
1974 
(29 
U.S.C. 
1181(f)(3)(B)(i)(II)). 
‘‘(II) OPTION TO PROVIDE CON-
CURRENT WITH PROVISION OF PLAN 
MATERIALS
TO
EMPLOYEE.—An em-
ployer may provide the model notice 
applicable to the State in which an 
employee resides concurrent with the 
furnishing of materials notifying the 
employee of health plan eligibility, 
concurrent with materials provided to 
the employee in connection with an 
open season or election process con-
ducted under the plan, or concurrent 
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with the furnishing of the summary 
plan description as provided in section 
104(b) of the Employee Retirement 
Income Security Act of 1974. 
‘‘(ii) 
DISCLOSURE
ABOUT
GROUP 
HEALTH PLAN BENEFITS TO STATES FOR 
MEDICAID- AND CHIP- ELIGIBLE INDIVID-
UALS.—In the case of an enrollee in a 
group health plan who is covered under a 
Medicaid plan of a State under title XIX 
of the Social Security Act or under a State 
child health plan under title XXI of such 
Act, the plan administrator of the group 
health plan shall disclose to the State, 
upon request, information about the bene-
fits available under the group health plan 
in sufficient specificity, as determined 
under regulations of the Secretary of 
Health and Human Services in consulta-
tion with the Secretary that require use of 
the model coverage coordination disclosure 
form developed under section 311(b)(1)(C) 
of the Children’s Health Insurance Reau-
thorization Act of 2009, so as to permit 
the State to establish (under paragraph 
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(2)(B), (3), or (10) of section 2105(c) of 
the Social Security Act or otherwise) the 
cost effectiveness of the State providing 
medical or child health assistance through 
premium assistance for the purchase of 
coverage under such group health plan and 
in order for the State to provide supple-
mental benefits required under paragraph 
(10)(E) of such section or other authority. 
‘‘(d) APPLICATION TO ASSOCIATION PLANS.— 
‘‘(1) IN
GENERAL.—A group health plan or 
health insurance issuer that provides coverage to an 
association as required under section 2711(a)(2) 
shall accept every qualified individual that the asso-
ciation seeks health insurance coverage for, without 
regard to the health status of such individual. 
‘‘(2) DEFINITIONS
RELATED
TO
ASSOCIA-
TIONS.—For purposes of this subsection: 
‘‘(A) ASSOCIATION.—The term ‘associa-
tion’ means an association that— 
‘‘(i) has a constitution and bylaws; 
‘‘(ii) is determined by the Secretary to 
be an association which is operating in 
good faith for a primary purpose other 
than that of obtaining insurance; and 
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‘‘(iii) has been in existence for a pe-
riod of at least 5 years. 
‘‘(B) DEPENDENT.—The term ‘dependent’, 
with respect to a qualified individual, has the 
meaning given such term in section 2714, with 
respect to a policy holder. 
‘‘(C) QUALIFIED
ACTUARY.—The term 
‘qualified actuary’ means a member in good 
standing of the American Academy of Actu-
aries, or a successor organization approved by 
the Secretary. 
‘‘(D) QUALIFIED INDIVIDUALS.—The term 
‘qualified individual’ means, with respect to an 
association, an individual who meets any of the 
following: 
‘‘(i) A member of the association who 
has been such a member for a period of at 
least 30 days. 
‘‘(ii) An employee of such member 
who has been employed by such member 
for a period of at least 30 days. 
‘‘(iii) An employee of the association 
who has been employed by the association 
for a period of at least 30 days.’’. 
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(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act is amended 
by adding at the end the following: 
‘‘SEC. 2746. PROHIBITION OF PREEXISTING CONDITION EX-
CLUSIONS 
OR 
OTHER 
DISCRIMINATION 
BASED ON HEALTH STATUS. 
‘‘The provisions of section 2701 (other than subpara-
graphs (A)(ii) and (B) of subsection (c)(3)) shall apply 
to health insurance coverage offered to individuals by a 
health insurance issuer in the individual market in the 
same manner as it applies to health insurance coverage 
offered by a health insurance issuer in the group market.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall be effective for plan years beginning on 
or after January 1, 2014, except, to the extent such 
amendments apply to enrollees who are under 19 years 
of age, such amendments shall become effective for plan 
years beginning on or after 6 months after the date of 
enactment of this Act. 
SEC. 6. NO LIFETIME OR ANNUAL LIMITS. 
(a) GROUP MARKET.—Subpart 2 of part A of title 
XXVII of the Public Health Service Act is amended by 
adding at the end the following: 
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‘‘SEC. 2708. NO LIFETIME OR ANNUAL LIMITS. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group health insurance coverage 
may not establish— 
‘‘(1) lifetime limits on the dollar value of bene-
fits for any participant or beneficiary; or 
‘‘(2) unreasonable annual limits (within the 
meaning of section 223 of the Internal Revenue 
Code of 1986) on the dollar value of benefits for any 
participant or beneficiary. 
‘‘(b) PER BENEFICIARY LIMITS.—A group health 
plan or health insurance coverage may not place annual 
or lifetime per beneficiary limits on specific covered bene-
fits unless such limits are otherwise permitted under Fed-
eral or State law.’’. 
(b) INDIVIDUAL MARKET.—Subpart 2 of part B of 
title XXVII of the Public Health Service Act is amended 
by adding at the end the following: 
‘‘SEC. 2754. NO LIFETIME OR ANNUAL LIMITS. 
‘‘The provisions of section 2708 shall apply to health 
insurance coverage offered to individuals by a health in-
surance issuer in the individual market in the same man-
ner as it applies to health insurance coverage offered by 
a health insurance issuer in the group market.’’. 
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(c) EFFECTIVE DATE.—The amendment made by 
this section shall be effective for plan years beginning on 
or after 6 months after the date of enactment of this Act. 
SEC. 7. PROHIBITION ON RESCISSIONS. 
(a) GROUP MARKET.—Subpart 1 of part A of title 
XXVII of the Public Health Service Act is amended by 
adding at the end the following: 
‘‘SEC. 2703. PROHIBITION ON RESCISSIONS. 
‘‘A group health plan and a health insurance issuer 
offering group health insurance coverage shall not rescind 
such plan or coverage with respect to an enrollee once the 
enrollee is covered under such plan or coverage involved, 
except that this section shall not apply to a covered indi-
vidual who has performed an act or practice that con-
stitutes fraud or makes an intentional misrepresentation 
of material fact as prohibited by the terms of the plan 
or coverage. Such plan or coverage may not be cancelled 
except with prior notice to the enrollee, and only as per-
mitted under section 2712(b).’’. 
(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act is amended 
by adding at the end the following: 
‘‘SEC. 2747. PROHIBITION ON RESCISSIONS. 
‘‘The provisions of section 2703 shall apply to health 
insurance coverage offered to individuals by a health in-
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surance issuer in the individual market in the same man-
ner as it applies to health insurance coverage offered by 
a health insurance issuer in the group market.’’. 
(c) EFFECTIVE DATE.—The amendment made by 
this section shall be effective for plan years beginning on 
or after 6 months after the date of enactment of this Act. 
SEC. 8. EXTENSION OF DEPENDENT COVERAGE. 
(a) GROUP MARKET.— 
(1) IN GENERAL.—Subpart 1 of part A of title 
XXVII of the Public Health Service Act is amended 
by adding at the end: 
‘‘SEC. 2703A. EXTENSION OF DEPENDENT COVERAGE. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group health insurance coverage 
that provides dependent coverage of children shall con-
tinue to make such coverage available for such a depend-
ent after such dependent turns 18 years of age until the 
first of the following events occurs: 
‘‘(1) The dependent turns 26 years of age. 
‘‘(2) The dependent marries. 
‘‘(3) Subject to subsection (c), the dependent no 
longer resides in the home of— 
‘‘(A) the policy holder through which such 
dependent is eligible for dependent coverage; or 
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‘‘(B) in the case that the policy holder 
through which such dependent is eligible for de-
pendent coverage provides such coverage subject 
to an order to provide child support, the de-
pendent’s parent or legal guardian. 
‘‘(b) EXCEPTION FOR COLLEGE STUDENTS.—Para-
graph (3) of subsection (a) shall not apply to a dependent 
for any period of time during which such dependent is en-
rolled as a full-time student at a postsecondary edu-
cational institution (including an institution of higher edu-
cation as defined in section 102 of the Higher Education 
Act of 1965). 
‘‘(c) LIMITATION.—Nothing in this section shall re-
quire a plan or an issuer described in subsection (a) to 
make coverage available for a child of an individual receiv-
ing dependent coverage pursuant to this section. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to modify the definition of ‘depend-
ent’ as used in the Internal Revenue Code of 1986 with 
respect to the tax treatment of the cost of coverage.’’. 
(2) REGULATIONS.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary shall promulgate regulations to define the de-
pendents to which coverage shall be made available 
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under section 2703A of the Public Health Service 
Act, as added by paragraph (1). 
(b) INDIVIDUAL MARKET.—Subpart 1 of part B of 
title XXVII of the Public Health Service Act is amended 
by adding at the end the following: 
‘‘SEC. 2748. EXTENSION OF DEPENDENT COVERAGE. 
‘‘The provisions of section 2703A shall apply to 
health insurance coverage offered to individuals by a 
health insurance issuer in the individual market in the 
same manner as it applies to health insurance coverage 
offered by a health insurance issuer in the group market.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall be effective for plan years beginning on 
or after 6 months after the date of enactment of this Act. 
SEC. 9. APPLICATION OF GROUP MARKET REFORMS TO 
ERISA AND THE INTERNAL REVENUE CODE 
OF 1986. 
(a) ERISA.— 
(1) IN GENERAL.—Subpart A of title VII of the 
Employee Retirement Income Security Act of 1974 
is amended— 
(A) by striking sections 701 and 703; and 
(B) by inserting before section 702 the fol-
lowing: 
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‘‘SEC. 701. APPLICATION OF CERTAIN PHSA REQUIRE-
MENTS. 
‘‘(a) IN GENERAL.—Sections 2701, 2703, 2703A, 
2708, 2711, and 2712 of the Public Health Service Act 
shall apply to group health plans, and health insurance 
issuers providing health insurance coverage in connection 
with group health plans, as if included in this subpart. 
‘‘(b) CONFLICT.—To the extent that any provision of 
this part conflicts with a provision of any section of the 
Public Health Service Act listed in subsection (a) with re-
spect to group health plans, or health insurance issuers 
providing health insurance coverage in connection with 
group health plans, the provisions of such sections shall 
apply.’’. 
(2) CONFORMING AMENDMENT.—The table of 
contents in section 1 of such Act is amended— 
(A) by striking the item related to section 
701 and inserting ‘‘Sec. 701. Application of cer-
tain PHSA requirements.’’; and 
(B) by striking the item related to section 
703. 
(b) INTERNAL REVENUE CODE
OF 1986.—Sub-
chapter A of chapter 100 of the Internal Revenue Code 
of 1986 (relating to group health plan requirements) is 
amended— 
(1) by striking sections 9801 and 9803; and 
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(2) by inserting before section 9802 the fol-
lowing: 
‘‘SEC. 9801. APPLICATION OF CERTAIN PHSA REQUIRE-
MENTS. 
‘‘(a) IN GENERAL.—Sections 2701, 2703, 2703A, 
2708, 2711, and 2712 of the Public Health Service Act 
shall apply to group health plans, and health insurance 
issuers providing health insurance coverage in connection 
with group health plans, as if included in this subchapter. 
‘‘(b) CONFLICT.—To the extent that any provision of 
this subchapter conflicts with a provision of any section 
of the Public Health Service Act listed in subsection (a) 
with respect to group health plans, or health insurance 
issuers providing health insurance coverage in connection 
with group health plans, the provisions of such sections 
shall apply.’’. 
SEC. 10. CATASTROPHIC PLAN. 
(a) IN GENERAL.—Subpart 1 of part B of title 
XXVII of the Public Health Service Act is amended by 
adding at the end the following: 
‘‘SEC. 2749. CATASTROPHIC PLAN. 
‘‘(a) IN GENERAL.—Each health insurance issuer 
that offers health insurance coverage in the individual 
market in a State shall offer a catastrophic plan in such 
State in such market. 
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‘‘(b) COVERAGE REQUIREMENTS.—To meet the re-
quirements of this section, a catastrophic plan must pro-
vide for the essential health benefits, as defined by the 
Secretary under subsection (c). 
‘‘(c) ESSENTIAL
HEALTH
BENEFITS.—The Sec-
retary shall define the essential health benefits, except 
that such benefits shall include— 
‘‘(1) coverage for at least three primary care 
visits during a plan year; and 
‘‘(2) at least the following general categories 
and the items and services covered within the cat-
egories: 
‘‘(A) Ambulatory patient services. 
‘‘(B) Emergency services. 
‘‘(C) Hospitalization. 
‘‘(D) Maternity and newborn care. 
‘‘(E) Mental health and substance use dis-
order services, including behavioral health treat-
ment. 
‘‘(F) Prescription drugs. 
‘‘(G) Rehabilitative and habilitative serv-
ices and devices. 
‘‘(H) Laboratory services. 
‘‘(I) Preventive and wellness services and 
chronic disease management. 
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‘‘(J) Pediatric services, including oral and 
vision care. 
‘‘(d) RESTRICTION TO INDIVIDUAL MARKET.—If a 
health insurance issuer offers a health plan described in 
this section, the issuer may only offer the plan in the indi-
vidual market.’’. 
(b) EFFECTIVE DATE.—This section shall be effec-
tive for plan years beginning on or after 6 months after 
the date of enactment of this Act. 
SEC. 11. GRANTS FOR HEALTH INSURANCE RISK ADJUST-
MENT MECHANISMS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall make grants to States for planning 
for the establishment and implementation of health insur-
ance risk adjustment mechanisms. 
(b) AMOUNT.— 
(1) IN GENERAL.—The Secretary shall deter-
mine the amount of a grant made to a State under 
this section pursuant to a formula, issued by rule 
not later than January 1, 2013, that takes into ac-
count the number of high-risk individuals in such 
State. 
(2) LIMITATION.—The amount of a grant made 
to a State under this section shall not exceed 
$1,000,000 for any fiscal year. 
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(c) USE OF FUNDS.—The grant funds made available 
to a State under this section may only be used by a State 
for the cost associated with planning for the establishment 
and implementation of health insurance risk adjustment 
mechanisms. Such funds may not be used for costs related 
to administering such mechanisms. 
(d) DEFINITIONS.—For purposes of this section: 
(1) HIGH-RISK INDIVIDUAL.—The term ‘‘high- 
risk individual’’ means an individual who— 
(A) is a citizen or national of the United 
States or is lawfully present in the United 
States; 
(B) has not been covered under creditable 
coverage (as defined in section 2701(c)(1) of 
the Public Health Service Act as in effect on 
March 22, 2010) during the previous 6-month 
period; and 
(C) has a preexisting condition, as deter-
mined in a manner consistent with guidance 
issued by the Secretary. 
(2) HEALTH
INSURANCE
RISK-ADJUSTMENT 
MECHANISMS.— 
(A) IN
GENERAL.—With respect to a 
State, the term ‘‘health insurance risk-adjust-
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ment mechanism’’ shall be a mechanism that 
applies to— 
(i) all health insurance issuers who 
offer health insurance coverage in such 
State; and 
(ii) all covered lives for health insur-
ance coverage offered in such State that is 
subject to the requirements of section 2711 
or section 2741 of the Public Health Serv-
ice Act, as added by section 3 of this Act. 
(B) FURTHER DEFINITION.—With respect 
to a State, any further definition of such term 
shall be determined by the State insurance com-
missioner, acting in cooperation with health in-
surance issuers who offer health insurance cov-
erage in such State. 
(3) STATE.—The term ‘‘State’’ means each of 
the 50 States and the District of Columbia. 
(e) SUNSET DATE.—The Secretary may not make 
any grants under this section after December 31, 2014. 
SEC. 12. LIABILITY PROTECTIONS FOR HEALTH CARE PRO-
VIDERS. 
(a) HEALTH CARE PROVIDERS PROTECTED.—The li-
ability protections in subsection (c) shall apply in any civil 
action, including an action before any court of any State, 
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against a health care provider, arising from health care 
goods or services that— 
(1) were provided by a health care provider in 
a hospital to which the requirements of section 1867 
of the Social Security Act (42 U.S.C. 1395dd) apply; 
and 
(2) were provided only because they were re-
quired under section 1867 of the Social Security Act 
(42 U.S.C. 1395dd). 
(b) BURDEN OF PROOF.—In any proceeding under 
subsection (a), the burden of proof shall be on the defend-
ant to establish the elements in paragraphs (1) and (2) 
of subsection (a). 
(c) LIABILITY PROTECTIONS.— 
(1) CAP
ON
NONECONOMIC
DAMAGES.—The 
amount of noneconomic damages, if available, shall 
not exceed $250,000, regardless of the number of 
parties against whom the action is brought with re-
spect to the same injury. An award for noneconomic 
damages in excess of $250,000 shall be reduced ei-
ther before entry of the order granting judgment, or 
by amendment of such order. 
(2) INSTALLMENT
PAYMENTS.—If the award 
for damages exceeds $50,000, the defendant may 
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pay such damages in installments, as determined by 
the court. 
(3) ATTORNEY FEES.—Any contingent fee for a 
party’s attorney shall not exceed— 
(A) 40 percent of the portion of the award 
amount that does not exceed $50,000; 
(B) 331⁄3 percent of the portion of the 
award amount that exceeds $50,000 but does 
not exceed $100,000; 
(C) 25 percent of the portion of the award 
amount that exceeds $100,000 but does not ex-
ceed $600,000; and 
(D) 15 percent of the portion of the award 
amount that exceeds $600,000. 
(4) DISCLOSURE OF COLLATERAL SOURCE BEN-
EFITS.—Any person bringing a civil action described 
in subsection (a) shall, and any party may, disclose 
or introduce evidence of collateral source benefits. 
(5) PREEMPTION.— 
(A) IN GENERAL.—The provisions of this 
Act preempt, subject to subparagraphs (B) and 
(C), State law to the extent that State law pre-
vents the application of any provisions of law 
established by or under this Act. The provisions 
governing an action described in subsection (a) 
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set forth in this Act supersede chapter 171 of 
title 28, United States Code, to the extent that 
such chapter— 
(i) provides for a greater amount of 
damages or contingent fees, a longer pe-
riod in which a health care lawsuit may be 
commenced, or a reduced applicability or 
scope of periodic payment of future dam-
ages, than provided in this Act; or 
(ii) prohibits the introduction of evi-
dence regarding collateral source benefits, 
or mandates or permits subrogation or a 
lien on collateral source benefits. 
(B) 
GREATER
PROTECTIONS
PRE-
SERVED.—This Act shall not preempt or super-
sede any State or Federal law that imposes 
greater procedural or substantive protections 
for health care providers from liability, loss, or 
damages than those provided by this Act or cre-
ate a cause of action. 
(C) RULE OF CONSTRUCTION.—No provi-
sion of this Act shall be construed to preempt— 
(i) any State law (whether effective 
before, on, or after the date of the enact-
ment of this Act) that specifies a par-
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ticular monetary amount of compensatory 
or punitive damages (or the total amount 
of damages) that may be awarded in an 
action described in subsection (a), regard-
less of whether such monetary amount is 
greater or lesser than is provided for under 
this Act; or 
(ii) any defense available to a party in 
an action described in subsection (a) under 
any other provision of State or Federal 
law. 
(6) DEFINITIONS.— 
(A) COLLATERAL SOURCE BENEFITS.—As 
used in this section, the term ‘‘collateral source 
benefits’’ means any amount paid or reasonably 
likely to be paid in the future to or on behalf 
of the claimant, or any service, product, or 
other benefit provided or reasonably likely to be 
provided in the future to or on behalf of the 
claimant, as a result of the personal harm, pur-
suant to— 
(i) any State or Federal health, sick-
ness, income-disability, accident, or work-
ers’ compensation law; 
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(ii) any health, sickness, income-dis-
ability, or accident insurance that provides 
health benefits or income-disability cov-
erage; 
(iii) any contract or agreement of any 
group, organization, partnership, or cor-
poration to provide, pay for, or reimburse 
the cost of medical, hospital, dental, or in-
come-disability benefits; and 
(iv) any other publicly or privately 
funded program. 
(B) NONECONOMIC DAMAGES.—As used in 
this section, the term ‘‘noneconomic damages’’ 
means damages for physical and emotional 
pain, suffering, inconvenience, physical impair-
ment, mental anguish, disfigurement, loss of en-
joyment of life, loss of society and companion-
ship, loss of consortium (other than loss of do-
mestic service), hedonic damages, injury to rep-
utation, and all other nonpecuniary losses of 
any kind or nature. 
(C) HEALTH CARE PROVIDER.—As used in 
this section, the term ‘‘health care provider’’ 
means any person or entity required by State or 
Federal laws or regulations to be licensed, reg-
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istered, or certified to provide health care serv-
ices, and being either so licensed, registered, or 
certified, or exempted from such requirement by 
other statute. 
(D) HEALTH CARE GOODS OR SERVICES.— 
As used in this section, the term ‘‘health care 
goods or services’’ means any goods or services 
provided by a health care organization, pro-
vider, or by any individual working under the 
supervision of a health care provider, that re-
lates to the diagnosis, prevention, or treatment 
of any human disease or impairment, or the as-
sessment or care of the health of human beings. 
Æ 
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