Protecting Patients from Deceptive Health Plans Act
Bill: H.R.7512 | Sponsor: Rep. Hayes, Jahana (D-CT)
Policy area: Health

Summary:
Protecting Patients from Deceptive Health Plans Act
This bill prohibits the sale of health insurance coverage arrangements that are exempt from the federal health insurance requirements unless the individual purchasing the arrangement is enrolled in a plan that provides minimum essential coverage. Further, excepted benefits must be paid without regard to the severity of the illness, injury, diagnosis, or other characteristics related to treatment.

To amend title XXVII of the Public Health Service Act, title I of the 
   Employee Retirement Income Security Act of 1974, and the Internal 
   Revenue Code of 1986 to limit enrollment in coverage for excepted 
  benefits to individuals enrolled in a health plan providing minimum 
                          essential coverage.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Patients from Deceptive 
Health Plans Act''.

SEC. 2. MODIFYING EXCEPTED BENEFITS WITH RESPECT TO CERTAIN PLANS.

    (a) Public Health Service Act.--
            (1) Additional requirements for excepted benefit.--Section 
        2722(c)(2) of the Public Health Service Act (42 U.S.C. 300gg-
        21(c)(2)) is amended--
                    (A) in subparagraph (B), by striking ``sponsor.'' 
                and inserting ``sponsor, or with respect to individual 
                coverage, under any health insurance coverage 
                maintained by the same health insurance issuer.''; and
                    (B) by adding at the end the following:
                    ``(D) Such benefits are paid without regard to, and 
                do not vary based on, the severity of the illness, 
                injury, diagnosis, or other characteristics related to 
                treatment for which such benefits are paid.
                    ``(E) With respect to such benefits, the separate 
                policy, certificate, or contract of insurance is 
                provided only to an individual enrolled in minimum 
                essential coverage (as defined in section 5000A(f) of 
                the Internal Revenue Code of 1986), and such minimum 
                essential coverage's share of the total allowed costs 
                (as determined for purposes of section 36B(c)(2)(C)(ii) 
                of such Code) of benefits provided under such minimum 
                essential coverage is greater than or equal to 60 
                percent of such costs.''.
            (2) Modification of certain excepted benefits.--Section 
        2791(c) of the Public Health Service Act (42 U.S.C. 300gg-
        91(c)) is amended--
                    (A) in paragraph (1)(A), by striking ``accident'' 
                and all that follows through ``combination thereof'', 
                and inserting ``disability income insurance''; and
                    (B) in paragraph (3), by adding at the end the 
                following:
                    ``(C) Coverage only for accident.''.
    (b) Employee Retirement Income Security Act.--
            (1) Additional requirements for excepted benefits.--Section 
        732(c)(2) of the Employee Retirement Income Security Act of 
        1974 (29 U.S.C. 1191a(c)(2)) is amended by adding at the end 
        the following:
                    ``(D) Such benefits are paid without regard to, and 
                do not vary based on, the severity of the illness, 
                injury, diagnosis, or other characteristics related to 
                treatment for which such benefits are paid.
                    ``(E) With respect to such benefits, the separate 
                policy, certificate, or contract of insurance is 
                provided only to a participant or beneficiary enrolled 
                in minimum essential coverage (as defined in section 
                5000A(f) of the Internal Revenue Code of 1986), and 
                such minimum essential coverage's share of the total 
                allowed costs (as determined for purposes of section 
                36B(c)(2)(C)(ii) of such Code) of benefits provided 
                under such minimum essential coverage is greater than 
                or equal to 60 percent of such costs.''.
            (2) Modification of certain excepted benefits.--Section 
        733(c) of the Employee Retirement Income Security Act of 1974 
        (29 U.S.C. 1191b(c)) is amended--
                    (A) in paragraph (1)(A), by striking ``accident'' 
                and all that follows through ``combination thereof'', 
                and inserting ``disability income insurance''; and
                    (B) in paragraph (3), by adding at the end the 
                following:
                    ``(C) Coverage only for accident.''.
    (c) Internal Revenue Code.--
            (1) Additional requirements for excepted benefits.--Section 
        9831(c)(2) of the Internal Revenue Code of 1986 is amended by 
        adding at the end the following:
                    ``(D) Such benefits are paid without regard to, and 
                do not vary based on, the severity of the illness, 
                injury, diagnosis, or other characteristics related to 
                treatment for which such benefits are paid.
                    ``(E) With respect to such benefits, the separate 
                policy, certificate, or contract of insurance is 
                provided only to a participant or beneficiary enrolled 
                in minimum essential coverage (as defined in section 
                5000A(f)), and such minimum essential coverage's share 
                of the total allowed costs (as determined for purposes 
                of section 36B(c)(2)(C)(ii)) of benefits provided under 
                such minimum essential coverage is greater than or 
                equal to 60 percent of such costs.''.
            (2) Modification of certain excepted benefits.--Section 
        9832(c) of the Internal Revenue Code of 1986 is amended--
                    (A) in paragraph (1)(A), by striking ``accident'' 
                and all that follows through ``combination thereof'', 
                and inserting ``disability income insurance''; and
                    (B) in paragraph (3), by adding at the end the 
                following:
                    ``(C) Coverage only for accident.''.
    (d) Effective Date.--The amendments made by this section shall take 
effect beginning January 1, 2023, and shall apply with respect to 
policies issued, sold, or renewed on or after such date.
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