Title: Maintaining Protections for Patients with Preexisting Conditions Act of 2018
Policy area: Health

Summary:
Ensuring Coverage for Patients with Pre-Existing Conditions Act
This bill establishes provisions under the Health Insurance Portability and Accountability Act of 1996 relating to the guaranteed availability of health insurance coverage as well as prohibitions against discriminatory practices based on preexisting conditions or health status; the bill also prohibits related exclusions or limitations of benefits and establishes certain enforcement mechanisms.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6898 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 6898

  To amend the Health Insurance Portability and Accountability Act to 
 ensure coverage for individuals with preexisting conditions, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 26, 2018

  Mr. Knight (for himself, Mr. Huizenga, Mr. Curtis, Mr. Denham, Mrs. 
  Mimi Walters of California, Mrs. Wagner, Mr. Blum, Mr. Valadao, Ms. 
    Herrera Beutler, Mr. Poliquin, and Mr. Renacci) 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 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 amend the Health Insurance Portability and Accountability Act to 
 ensure coverage for individuals with preexisting conditions, and for 
                            other purposes.

    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 ``Maintaining Protections for Patients 
with Preexisting Conditions Act of 2018''.

SEC. 2. GUARANTEED AVAILABILITY OF COVERAGE; PROHIBITING 
              DISCRIMINATION.

    (a) In General.--Subtitle C of title I of the Health Insurance 
Portability and Accountability Act of 1996 (Public Law 104-191) is 
amended by adding at the end the following:

``SEC. 196. GUARANTEED AVAILABILITY OF COVERAGE.

    ``(a) Guaranteed Issuance of Coverage in the Individual and Group 
Market.--Subject to subsections (b) through (d), each health insurance 
issuer that offers health insurance coverage in the individual or group 
market in a State must accept every employer and individual in the 
State that applies for such coverage.
    ``(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 accordance with the regulations 
        promulgated under paragraph (3), establish special enrollment 
        periods for qualifying events (under section 603 of the 
        Employee Retirement Income Security Act of 1974).
            ``(3) Regulations.--The Secretary shall promulgate 
        regulations with respect to enrollment periods under paragraphs 
        (1) and (2).
    ``(c) Special Rules for Network Plans.--
            ``(1) In general.--In the case of a health insurance issuer 
        that offers health insurance coverage in the group and 
        individual market through a network plan, the issuer may--
                    ``(A) limit the employers that may apply for such 
                coverage to those with eligible individuals 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 and individuals if the 
                issuer has demonstrated, if required, to the applicable 
                State authority that--
                            ``(i) it will not have the capacity to 
                        deliver services adequately to enrollees of any 
                        additional groups or any additional individuals 
                        because of its obligations to existing group 
                        contract holders and enrollees; and
                            ``(ii) it is applying this paragraph 
                        uniformly to all employers and individuals 
                        without regard to the claims experience of 
                        those individuals, employers and their 
                        employees (and their dependents), or any health 
                        status-related factor relating to such 
                        individuals, employees, and dependents.
            ``(2) 180-day suspension upon denial of coverage.--An 
        issuer, upon denying health insurance coverage in any service 
        area in accordance with paragraph (1)(B), may not offer 
        coverage in the group or individual market within such service 
        area for a period of 180 days after the date such coverage is 
        denied.
    ``(d) Application of Financial Capacity Limits.--
            ``(1) In general.--A health insurance issuer may deny 
        health insurance coverage in the group or individual market if 
        the issuer has demonstrated, if required, to the applicable 
        State authority that--
                    ``(A) it does not have the financial reserves 
                necessary to underwrite additional coverage; and
                    ``(B) it is applying this paragraph uniformly to 
                all employers and individuals in the group or 
                individual market in the State consistent with 
                applicable State law and without regard to the claims 
                experience of those individuals, employers and their 
                employees (and their dependents) or 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 or individual market in the State for 
        a period of 180 days after the date such coverage is denied or 
        until the issuer has demonstrated to the applicable State 
        authority, if required under applicable State law, that the 
        issuer has sufficient financial 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.
    ``(e) Definitions.--In this section and in sections 197 through 
199A:
            ``(1) The term `Secretary' means the Secretary of Health 
        and Human Services.
            ``(2) The terms `genetic information', `genetic test', 
        `group health plan', `group market', `health insurance 
        coverage', `health insurance issuer', `group health insurance 
        coverage', `individual health insurance coverage', `individual 
        market', and `underwriting purpose' have the meanings given 
        such terms in section 2791 of the Public Health Service Act.

``SEC. 197. FAIR HEALTH INSURANCE PREMIUMS.

    ``(a) Prohibiting Discriminatory Premium Rates.--
            ``(1) In general.--With respect to the premium rate charged 
        by a health insurance issuer for health insurance coverage 
        offered in the individual or small group market--
                    ``(A) such rate shall vary with respect to the 
                particular plan or coverage involved only by--
                            ``(i) whether such plan or coverage covers 
                        an individual or family;
                            ``(ii) rating area, as established in 
                        accordance with paragraph (2);
                            ``(iii) age, except that such rate shall 
                        not vary by more than 3 to 1 for adults; and
                            ``(iv) tobacco use, except that such rate 
                        shall not vary by more than 1.5 to 1; and
                    ``(B) such rate shall not vary with respect to the 
                particular plan or coverage involved by any other 
                factor not described in subparagraph (A).
            ``(2) Rating area.--
                    ``(A) In general.--Each State shall establish 1 or 
                more rating areas within that State for purposes of 
                applying the requirements of this title.
                    ``(B) Secretarial review.--The Secretary shall 
                review the rating areas established by each State under 
                subparagraph (A) to ensure the adequacy of such areas 
                for purposes of carrying out the requirements of this 
                title. If the Secretary determines a State's rating 
                areas are not adequate, or that a State does not 
                establish such areas, the Secretary may establish 
                rating areas for that State.
            ``(3) Permissible age bands.--The Secretary, in 
        consultation with the National Association of Insurance 
        Commissioners, shall define the permissible age bands for 
        rating purposes under paragraph (1)(A)(iii).
            ``(4) Application of variations based on age or tobacco 
        use.--With respect to family coverage under a group health plan 
        or health insurance coverage, the rating variations permitted 
        under clauses (iii) and (iv) of paragraph (1)(A) shall be 
        applied based on the portion of the premium that is 
        attributable to each family member covered under the plan or 
        coverage.

``SEC. 198. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS 
              AND BENEFICIARIES BASED ON HEALTH STATUS.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
establish rules for eligibility (including continued eligibility) of 
any individual to enroll under the terms of the plan or coverage based 
on any of the following health status-related factors in relation to 
the individual or a dependent of the individual:
            ``(1) Health status.
            ``(2) Medical condition (including both physical and mental 
        illnesses).
            ``(3) Claims experience.
            ``(4) Receipt of health care.
            ``(5) Medical history.
            ``(6) Genetic information.
            ``(7) Evidence of insurability (including conditions 
        arising out of acts of domestic violence).
            ``(8) Disability.
            ``(9) Any other health status-related factor determined 
        appropriate by the Secretary.
    ``(b) In Premium Contributions.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering group or individual health insurance 
        coverage, may not require any individual (as a condition of 
        enrollment or continued enrollment under the plan) to pay a 
        premium or contribution which is greater than such premium or 
        contribution for a similarly situated individual enrolled in 
        the plan on the basis of any health status-related factor in 
        relation to the individual or to an individual enrolled under 
        the plan as a dependent of the individual.
            ``(2) Construction.--Nothing in paragraph (1) shall be 
        construed--
                    ``(A) to restrict the amount that an employer or 
                individual may be charged for coverage under a group 
                health plan except as provided in paragraph (3) or 
                individual health coverage, as the case may be; or
                    ``(B) to prevent a group health plan, and a health 
                insurance issuer offering group health insurance 
                coverage, from establishing premium discounts or 
                rebates or modifying otherwise applicable copayments or 
                deductibles in return for adherence to programs of 
                health promotion and disease prevention.
            ``(3) No group-based discrimination on basis of genetic 
        information.--
                    ``(A) In general.--For purposes of this section, a 
                group health plan, and health insurance issuer offering 
                group health insurance coverage in connection with a 
                group health plan, may not adjust premium or 
                contribution amounts for the group covered under such 
                plan on the basis of genetic information.
                    ``(B) Rule of construction.--Nothing in 
                subparagraph (A) or in paragraphs (1) and (2) of 
                subsection (d) shall be construed to limit the ability 
                of a health insurance issuer offering group or 
                individual health insurance coverage to increase the 
                premium for an employer based on the manifestation of a 
                disease or disorder of an individual who is enrolled in 
                the plan. In such case, the manifestation of a disease 
                or disorder in one individual cannot also be used as 
                genetic information about other group members and to 
                further increase the premium for the employer.
    ``(c) Genetic Testing.--
            ``(1) Limitation on requesting or requiring genetic 
        testing.--A group health plan, and a health insurance issuer 
        offering health insurance coverage in connection with a group 
        health plan, shall not request or require an individual or a 
        family member of such individual to undergo a genetic test.
            ``(2) Rule of construction.--Paragraph (1) shall not be 
        construed to limit the authority of a health care professional 
        who is providing health care services to an individual to 
        request that such individual undergo a genetic test.
            ``(3) Rule of construction regarding payment.--
                    ``(A) In general.--Nothing in paragraph (1) shall 
                be construed to preclude a group health plan, or a 
                health insurance issuer offering health insurance 
                coverage in connection with a group health plan, from 
                obtaining and using the results of a genetic test in 
                making a determination regarding payment (as such term 
                is defined for the purposes of applying the regulations 
                promulgated by the Secretary under part C of title XI 
                of the Social Security Act and section 264 of this Act, 
                as may be revised from time to time) consistent with 
                subsection (a).
                    ``(B) Limitation.--For purposes of subparagraph 
                (A), a group health plan, or a health insurance issuer 
                offering health insurance coverage in connection with a 
                group health plan, may request only the minimum amount 
                of information necessary to accomplish the intended 
                purpose.
            ``(4) Research exception.--Notwithstanding paragraph (1), a 
        group health plan, or a health insurance issuer offering health 
        insurance coverage in connection with a group health plan, may 
        request, but not require, that a participant or beneficiary 
        undergo a genetic test if each of the following conditions is 
        met:
                    ``(A) The request is made pursuant to research that 
                complies with part 46 of title 45, Code of Federal 
                Regulations, or equivalent Federal regulations, and any 
                applicable State or local law or regulations for the 
                protection of human subjects in research.
                    ``(B) The plan or issuer clearly indicates to each 
                participant or beneficiary, or in the case of a minor 
                child, to the legal guardian of such beneficiary, to 
                whom the request is made that--
                            ``(i) compliance with the request is 
                        voluntary; and
                            ``(ii) noncompliance will have no effect on 
                        enrollment status or premium or contribution 
                        amounts.
                    ``(C) No genetic information collected or acquired 
                under this paragraph shall be used for underwriting 
                purposes.
                    ``(D) The plan or issuer notifies the Secretary in 
                writing that the plan or issuer is conducting 
                activities pursuant to the exception provided for under 
                this paragraph, including a description of the 
                activities conducted.
                    ``(E) The plan or issuer complies with such other 
                conditions as the Secretary may by regulation require 
                for activities conducted under this paragraph.
    ``(d) Prohibition on Collection of Genetic Information.--
            ``(1) In general.--A group health plan, and a health 
        insurance issuer offering health insurance coverage in 
        connection with a group health plan, shall not request, 
        require, or purchase genetic information for underwriting 
        purposes.
            ``(2) Prohibition on collection of genetic information 
        prior to enrollment.--A group health plan, and a health 
        insurance issuer offering health insurance coverage in 
        connection with a group health plan, shall not request, 
        require, or purchase genetic information with respect to any 
        individual prior to such individual's enrollment under the plan 
        or coverage in connection with such enrollment.
            ``(3) Incidental collection.--If a group health plan, or a 
        health insurance issuer offering health insurance coverage in 
        connection with a group health plan, obtains genetic 
        information incidental to the requesting, requiring, or 
        purchasing of other information concerning any individual, such 
        request, requirement, or purchase shall not be considered a 
        violation of paragraph (2) if such request, requirement, or 
        purchase is not in violation of paragraph (1).
    ``(e) Genetic Information of a Fetus or Embryo.--Any reference in 
this part to genetic information concerning an individual or family 
member of an individual shall--
            ``(1) with respect to such an individual or family member 
        of an individual who is a pregnant woman, include genetic 
        information of any fetus carried by such pregnant woman; and
            ``(2) with respect to an individual or family member 
        utilizing an assisted reproductive technology, include genetic 
        information of any embryo legally held by the individual or 
        family member.
    ``(f) Programs of Health Promotion or Disease Prevention.--
            ``(1) General provisions.--
                    ``(A) General rule.--For purposes of subsection 
                (b)(2)(B), a program of health promotion or disease 
                prevention (referred to in this subsection as a 
                `wellness program') shall be a program offered by an 
                employer that is designed to promote health or prevent 
                disease that meets the applicable requirements of this 
                subsection.
                    ``(B) No conditions based on health status 
                factor.--If none of the conditions for obtaining a 
                premium discount or rebate or other reward for 
                participation in a wellness program is based on an 
                individual satisfying a standard that is related to a 
                health status factor, such wellness program shall not 
                violate this section if participation in the program is 
                made available to all similarly situated individuals 
                and the requirements of paragraph (2) are complied 
                with.
                    ``(C) Conditions based on health status factor.--If 
                any of the conditions for obtaining a premium discount 
                or rebate or other reward for participation in a 
                wellness program is based on an individual satisfying a 
                standard that is related to a health status factor, 
                such wellness program shall not violate this section if 
                the requirements of paragraph (3) are complied with.
            ``(2) Wellness programs not subject to requirements.--If 
        none of the conditions for obtaining a premium discount or 
        rebate or other reward under a wellness program as described in 
        paragraph (1)(B) are based on an individual satisfying a 
        standard that is related to a health status factor (or if such 
        a wellness program does not provide such a reward), the 
        wellness program shall not violate this section if 
        participation in the program is made available to all similarly 
        situated individuals. The following programs shall not have to 
        comply with the requirements of paragraph (3) if participation 
        in the program is made available to all similarly situated 
        individuals:
                    ``(A) A program that reimburses all or part of the 
                cost for memberships in a fitness center.
                    ``(B) A diagnostic testing program that provides a 
                reward for participation and does not base any part of 
                the reward on outcomes.
                    ``(C) A program that encourages preventive care 
                related to a health condition through the waiver of the 
                copayment or deductible requirement under group health 
                plan for the costs of certain items or services related 
                to a health condition (such as prenatal care or well-
                baby visits).
                    ``(D) A program that reimburses individuals for the 
                costs of smoking cessation programs without regard to 
                whether the individual quits smoking.
                    ``(E) A program that provides a reward to 
                individuals for attending a periodic health education 
                seminar.
            ``(3) Wellness programs subject to requirements.--If any of 
        the conditions for obtaining a premium discount, rebate, or 
        reward under a wellness program as described in paragraph 
        (1)(C) is based on an individual satisfying a standard that is 
        related to a health status factor, the wellness program shall 
        not violate this section if the following requirements are 
        complied with:
                    ``(A) The reward for the wellness program, together 
                with the reward for other wellness programs with 
                respect to the plan that requires satisfaction of a 
                standard related to a health status factor, shall not 
                exceed 30 percent of the cost of employee-only coverage 
                under the plan. If, in addition to employees or 
                individuals, any class of dependents (such as spouses 
                or spouses and dependent children) may participate 
                fully in the wellness program, such reward shall not 
                exceed 30 percent of the cost of the coverage in which 
                an employee or individual and any dependents are 
                enrolled. For purposes of this paragraph, the cost of 
                coverage shall be determined based on the total amount 
                of employer and employee contributions for the benefit 
                package under which the employee is (or the employee 
                and any dependents are) receiving coverage. A reward 
                may be in the form of a discount or rebate of a premium 
                or contribution, a waiver of all or part of a cost-
                sharing mechanism (such as deductibles, copayments, or 
                coinsurance), the absence of a surcharge, or the value 
                of a benefit that would otherwise not be provided under 
                the plan. The Secretaries of Labor, Health and Human 
                Services, and the Treasury may increase the reward 
                available under this subparagraph to up to 50 percent 
                of the cost of coverage if the Secretaries determine 
                that such an increase is appropriate.
                    ``(B) The wellness program shall be reasonably 
                designed to promote health or prevent disease. A 
                program complies with the preceding sentence if the 
                program has a reasonable chance of improving the health 
                of, or preventing disease in, participating individuals 
                and it is not overly burdensome, is not a subterfuge 
                for discriminating based on a health status factor, and 
                is not highly suspect in the method chosen to promote 
                health or prevent disease.
                    ``(C) The plan shall give individuals eligible for 
                the program the opportunity to qualify for the reward 
                under the program at least once each year.
                    ``(D) The full reward under the wellness program 
                shall be made available to all similarly situated 
                individuals. For such purpose, among other things:
                            ``(i) The reward is not available to all 
                        similarly situated individuals for a period 
                        unless the wellness program allows--
                                    ``(I) for a reasonable alternative 
                                standard (or waiver of the otherwise 
                                applicable standard) for obtaining the 
                                reward for any individual for whom, for 
                                that period, it is unreasonably 
                                difficult due to a medical condition to 
                                satisfy the otherwise applicable 
                                standard; and
                                    ``(II) for a reasonable alternative 
                                standard (or waiver of the otherwise 
                                applicable standard) for obtaining the 
                                reward for any individual for whom, for 
                                that period, it is medically 
                                inadvisable to attempt to satisfy the 
                                otherwise applicable standard.
                            ``(ii) If reasonable under the 
                        circumstances, the plan or issuer may seek 
                        verification, such as a statement from an 
                        individual's physician, that a health status 
                        factor makes it unreasonably difficult or 
                        medically inadvisable for the individual to 
                        satisfy or attempt to satisfy the otherwise 
                        applicable standard.
                    ``(E) The plan or issuer involved shall disclose in 
                all plan materials describing the terms of the wellness 
                program the availability of a reasonable alternative 
                standard (or the possibility of waiver of the otherwise 
                applicable standard) required under subparagraph (D). 
                If plan materials disclose that such a program is 
                available, without describing its terms, the disclosure 
                under this subparagraph shall not be required.

``SEC. 199. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER 
              DISCRIMINATION BASED ON HEALTH STATUS.

    ``(a) In General.--A group health plan and a health insurance 
issuer offering group or individual health insurance coverage may not 
impose any preexisting condition exclusion with respect to such plan or 
coverage.
    ``(b) Definitions.--For purposes of this section--
            ``(1) Preexisting condition exclusion.--
                    ``(A) In general.--The term `preexisting condition 
                exclusion' means, with respect to 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 for such 
                coverage, whether or not any medical advice, diagnosis, 
                care, or treatment was recommended or received before 
                such date.
                    ``(B) Treatment of genetic information.--Genetic 
                information shall not be treated as a condition 
                described in subsection (a)(1) in the absence of a 
                diagnosis of the condition related to such information.
            ``(2) Enrollment date.--The term `enrollment date' means, 
        with respect to an individual covered under a group health plan 
        or health insurance coverage, the date of enrollment of the 
        individual in the plan or coverage or, if earlier, the first 
        day of the waiting period for such enrollment.
            ``(3) Late enrollee.--The term `late enrollee' means, with 
        respect to coverage under a group health plan, a participant or 
        beneficiary who enrolls under the plan other than during--
                    ``(A) the first period in which the individual is 
                eligible to enroll under the plan; or
                    ``(B) a special enrollment period under subsection 
                (f).
            ``(4) Waiting period.--The term `waiting period' means, 
        with respect to a group health plan and an individual who is a 
        potential participant or beneficiary in the plan, the period 
        that must pass with respect to the individual before the 
        individual is eligible to be covered for benefits under the 
        terms of the plan.
    ``(c) Rules Relating to Crediting Previous Coverage.--
            ``(1) Creditable coverage defined.--For purposes of this 
        title, the term `creditable coverage' means, with respect to an 
        individual, coverage of the individual under any of the 
        following:
                    ``(A) A group health plan.
                    ``(B) Health insurance coverage.
                    ``(C) Part A or part B of title XVIII of the Social 
                Security Act.
                    ``(D) Title XIX of the Social Security Act, other 
                than coverage consisting solely of benefits under 
                section 1928.
                    ``(E) Chapter 55 of title 10, United States Code.
                    ``(F) A medical care program of the Indian Health 
                Service or of a tribal organization.
                    ``(G) A State health benefits risk pool.
                    ``(H) A health plan offered under chapter 89 of 
                title 5, United States Code.
                    ``(I) A public health plan (as defined in 
                regulations).
                    ``(J) A health benefit plan under section 5(e) of 
                the Peace Corps Act (22 U.S.C. 2504(e)).
        Such term does not include coverage consisting solely of 
        coverage of excepted benefits (as defined in section 2791(c)).
            ``(2) Not counting periods before significant breaks in 
        coverage.--
                    ``(A) In general.--A period of creditable coverage 
                shall not be counted, with respect to enrollment of an 
                individual under a group or individual health plan, if, 
                after such period and before the enrollment date, there 
                was a 63-day period during all of which the individual 
                was not covered under any creditable coverage.
                    ``(B) Waiting period not treated as a break in 
                coverage.--For purposes of subparagraph (A) and 
                subsection (d)(4), any period that an individual is in 
                a waiting period for any coverage under a group or 
                individual health plan (or for group health insurance 
                coverage) or is in an affiliation period (as defined in 
                subsection (g)(2)) shall not be taken into account in 
                determining the continuous period under subparagraph 
                (A).
                    ``(C) TAA-eligible individuals.--In the case of 
                plan years beginning before January 1, 2014--
                            ``(i) TAA pre-certification period rule.--
                        In the case of a TAA-eligible individual, the 
                        period beginning on the date the individual has 
                        a TAA-related loss of coverage and ending on 
                        the date that is 7 days after the date of the 
                        issuance by the Secretary (or by any person or 
                        entity designated by the Secretary) of a 
                        qualified health insurance costs credit 
                        eligibility certificate for such individual for 
                        purposes of section 7527 of the Internal 
                        Revenue Code of 1986 shall not be taken into 
                        account in determining the continuous period 
                        under subparagraph (A).
                            ``(ii) Definitions.--The terms `TAA-
                        eligible individual' and `TAA-related loss of 
                        coverage' have the meanings given such terms in 
                        section 2205(b)(4).
            ``(3) Method of crediting coverage.--
                    ``(A) Standard method.--Except as otherwise 
                provided under subparagraph (B), for purposes of 
                applying subsection (a)(3), a group health plan, and a 
                health insurance issuer offering group or individual 
                health insurance coverage, shall count a period of 
                creditable coverage without regard to the specific 
                benefits covered during the period.
                    ``(B) Election of alternative method.--A group 
                health plan, or a health insurance issuer offering 
                group or individual health insurance, may elect to 
                apply subsection (a)(3) based on coverage of benefits 
                within each of several classes or categories of 
                benefits specified in regulations rather than as 
                provided under subparagraph (A). Such election shall be 
                made on a uniform basis for all participants and 
                beneficiaries. Under such election a group or 
                individual health plan or issuer shall count a period 
                of creditable coverage with respect to any class or 
                category of benefits if any level of benefits is 
                covered within such class or category.
                    ``(C) Plan notice.--In the case of an election with 
                respect to a group health plan under subparagraph (B) 
                (whether or not health insurance coverage is provided 
                in connection with such plan), the plan shall--
                            ``(i) prominently state in any disclosure 
                        statements concerning the plan, and state to 
                        each enrollee at the time of enrollment under 
                        the plan, that the plan has made such election; 
                        and
                            ``(ii) include in such statements a 
                        description of the effect of this election.
                    ``(D) Issuer notice.--In the case of an election 
                under subparagraph (B) with respect to health insurance 
                coverage offered by an issuer in the individual or 
                group market, the issuer--
                            ``(i) shall prominently state in any 
                        disclosure statements concerning the coverage, 
                        and to each employer at the time of the offer 
                        or sale of the coverage, that the issuer has 
                        made such election; and
                            ``(ii) shall include in such statements a 
                        description of the effect of such election.
            ``(4) Establishment of period.--Periods of creditable 
        coverage with respect to an individual shall be established 
        through presentation of certifications described in subsection 
        (e) or in such other manner as may be specified in regulations.
    ``(d) Exceptions.--
            ``(1) Exclusion not applicable to certain newborns.--
        Subject to paragraph (4), a group health plan, and a health 
        insurance issuer offering group or individual health insurance 
        coverage, may not impose any preexisting condition exclusion in 
        the case of an individual who, as of the last day of the 30-day 
        period beginning with the date of birth, is covered under 
        creditable coverage.
            ``(2) Exclusion not applicable to certain adopted 
        children.--Subject to paragraph (4), a group health plan, and a 
        health insurance issuer offering group or individual health 
        insurance coverage, may not impose any preexisting condition 
        exclusion in the case of a child who is adopted or placed for 
        adoption before attaining 18 years of age and who, as of the 
        last day of the 30-day period beginning on the date of the 
        adoption or placement for adoption, is covered under creditable 
        coverage. The previous sentence shall not apply to coverage 
        before the date of such adoption or placement for adoption.
            ``(3) Exclusion not applicable to pregnancy.--A group 
        health plan, and health insurance issuer offering group or 
        individual health insurance coverage, may not impose any 
        preexisting condition exclusion relating to pregnancy as a 
        preexisting condition.
            ``(4) Loss if break in coverage.--Paragraphs (1) and (2) 
        shall no longer apply to an individual after the end of the 
        first 63-day period during all of which the individual was not 
        covered under any creditable coverage.
    ``(e) Certifications and Disclosure of Coverage.--
            ``(1) Requirement for certification of period of creditable 
        coverage.--
                    ``(A) In general.--A group health plan, and a 
                health insurance issuer offering group or individual 
                health insurance coverage, shall provide the 
                certification described in subparagraph (B)--
                            ``(i) at the time an individual ceases to 
                        be covered under the plan or otherwise becomes 
                        covered under a COBRA continuation provision;
                            ``(ii) in the case of an individual 
                        becoming covered under such a provision, at the 
                        time the individual ceases to be covered under 
                        such provision; and
                            ``(iii) on the request on behalf of an 
                        individual made not later than 24 months after 
                        the date of cessation of the coverage described 
                        in clause (i) or (ii), whichever is later.
                The certification under clause (i) may be provided, to 
                the extent practicable, at a time consistent with 
                notices required under any applicable COBRA 
                continuation provision.
                    ``(B) Certification.--The certification described 
                in this subparagraph is a written certification of--
                            ``(i) the period of creditable coverage of 
                        the individual under such plan and the coverage 
                        (if any) under such COBRA continuation 
                        provision; and
                            ``(ii) the waiting period (if any) (and 
                        affiliation period, if applicable) imposed with 
                        respect to the individual for any coverage 
                        under such plan.
                    ``(C) Issuer compliance.--To the extent that 
                medical care under a group health plan consists of 
                group health insurance coverage, the plan is deemed to 
                have satisfied the certification requirement under this 
                paragraph if the health insurance issuer offering the 
                coverage provides for such certification in accordance 
                with this paragraph.
            ``(2) Disclosure of information on previous benefits.--In 
        the case of an election described in subsection (c)(3)(B) by a 
        group health plan or health insurance issuer, if the plan or 
        issuer enrolls an individual for coverage under the plan and 
        the individual provides a certification of coverage of the 
        individual under paragraph (1)--
                    ``(A) upon request of such plan or issuer, the 
                entity which issued the certification provided by the 
                individual shall promptly disclose to such requesting 
                plan or issuer information on coverage of classes and 
                categories of health benefits available under such 
                entity's plan or coverage; and
                    ``(B) such entity may charge the requesting plan or 
                issuer for the reasonable cost of disclosing such 
                information.
            ``(3) Regulations.--The Secretary shall establish rules to 
        prevent an entity's failure to provide information under 
        paragraph (1) or (2) with respect to previous coverage of an 
        individual from adversely affecting any subsequent coverage of 
        the individual under another group health plan or health 
        insurance coverage.
    ``(f) Special Enrollment Periods.--
            ``(1) Individuals losing other coverage.--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 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 if each of the following conditions is met:
                    ``(A) The employee or dependent was covered 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 reason 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 coverage 
                described in subparagraph (A)--
                            ``(i) was under a COBRA continuation 
                        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 coverage 
                        (including as a result of legal separation, 
                        divorce, death, termination of employment, 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 employee 
                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 coverage 
                        available with respect to a dependent of an 
                        individual;
                            ``(ii) the individual is a participant 
                        under the plan (or has met any waiting period 
                        applicable to becoming a participant 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 dependent 
                        of the individual through marriage, birth, or 
                        adoption or placement for adoption,
                the group health plan shall provide for a dependent 
                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 adoption 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 period 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 the case 
                        may be) described in subparagraph (A)(iii).
                    ``(C) No waiting period.--If an individual seeks to 
                enroll a dependent during the first 30 days of such a 
                dependent special enrollment 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 beginning 
                        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 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 if either of the following conditions is met:
                            ``(i) Termination of medicaid or chip 
                        coverage.--The employee or dependent 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 eligibility 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 
                        termination of such coverage.
                            ``(ii) Eligibility for employment 
                        assistance under medicaid or chip.--The 
                        employee or dependent becomes eligible for 
                        assistance, with respect to coverage under the 
                        group health plan or health insurance coverage, 
                        under such Medicaid plan or State child health 
                        plan (including 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 insurance coverage not later than 60 
                        days after the date the employee or dependent 
                        is determined to be eligible for such 
                        assistance.
                    ``(B) Coordination with medicaid and chip.--
                            ``(i) Outreach to employees regarding 
                        availability of medicaid and chip coverage.--
                                    ``(I) In general.--Each employer 
                                that maintains a group health plan in a 
                                State that provides medical assistance 
                                under a State Medicaid plan under title 
                                XIX of the Social Security 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 of 
                                potential opportunities then currently 
                                available in the State in which the 
                                employee resides for premium assistance 
                                under such plans for health coverage of 
                                the employee or the employee'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 concurrent 
                                with provision of plan materials to 
                                employee.--An employer 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 
                                conducted under the plan, or concurrent 
                                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 individuals.--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 benefits available under 
                        the group health plan in sufficient 
                        specificity, as determined under regulations of 
                        the Secretary of Health and Human Services in 
                        consultation 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 
                        Reauthorization Act of 2009, so as to permit 
                        the State to make a determination (under 
                        paragraph (2)(B), (3), or (10) of section 
                        2105(c) of the Social Security Act or 
                        otherwise) concerning 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 
                        supplemental benefits required under paragraph 
                        (10)(E) of such section or other authority.
    ``(g) Use of Affiliation Period by HMOs as Alternative to 
Preexisting Condition Exclusion.--
            ``(1) In general.--A health maintenance organization which 
        offers health insurance coverage in connection with a group 
        health plan and which does not impose any preexisting condition 
        exclusion allowed under subsection (a) with respect to any 
        particular coverage option may impose an affiliation period for 
        such coverage option, but only if--
                    ``(A) such period is applied uniformly without 
                regard to any health status-related factors; and
                    ``(B) such period does not exceed 2 months (or 3 
                months in the case of a late enrollee).
            ``(2) Affiliation period.--
                    ``(A) Defined.--For purposes of this title, the 
                term `affiliation period' means a period which, under 
                the terms of the health insurance coverage offered by 
                the health maintenance organization, must expire before 
                the health insurance coverage becomes effective. The 
                organization is not required to provide health care 
                services or benefits during such period and no premium 
                shall be charged to the participant or beneficiary for 
                any coverage during the period.
                    ``(B) Beginning.--Such period shall begin on the 
                enrollment date.
                    ``(C) Runs concurrently with waiting periods.--An 
                affiliation period under a plan shall run concurrently 
                with any waiting period under the plan.
            ``(3) Alternative methods.--A health maintenance 
        organization described in paragraph (1) may use alternative 
        methods, from those described in such paragraph, to address 
        adverse selection as approved by the State insurance 
        commissioner or official or officials designated by the State 
        to enforce the requirements of this part for the State involved 
        with respect to such issuer.

``SEC. 199A. ENFORCEMENT OF CERTAIN HEALTH INSURANCE REQUIREMENTS.

    ``(a) State Enforcement.--
            ``(1) State authority.--Each State may require that health 
        insurance issuers that issue, sell, renew, or offer health 
        insurance coverage in the State in the individual or group 
        market meet the requirements of this part with respect to such 
        issuers.
            ``(2) Failure to implement provisions.--In the case of a 
        determination by the Secretary that a State has failed to 
        substantially enforce a provision (or provisions) of sections 
        196 through 199 with respect to health insurance issuers in the 
        State, the Secretary shall enforce such provision (or 
        provisions) under subsection (b) insofar as they relate to the 
        issuance, sale, renewal, and offering of health insurance 
        coverage in connection with group health plans or individual 
        health insurance coverage in such State.
    ``(b) Secretarial Enforcement Authority.--
            ``(1) Limitation.--The provisions of this subsection shall 
        apply to enforcement of a provision (or provisions) described 
        in subsection (a)(2) only--
                    ``(A) as provided under such subsection; and
                    ``(B) with respect to individual health insurance 
                coverage or group health plans that are non-Federal 
                governmental plans.
            ``(2) Imposition of penalties.--In the cases described in 
        paragraph (1)--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, any non-Federal 
                governmental plan that is a group health plan and any 
                health insurance issuer that fails to meet a provision 
                of this part applicable to such plan or issuer is 
                subject to a civil money penalty under this subsection.
                    ``(B) Liability for penalty.--In the case of a 
                failure by--
                            ``(i) a health insurance issuer, the issuer 
                        is liable for such penalty; or
                            ``(ii) a group health plan that is a non-
                        Federal governmental plan which is--
                                    ``(I) sponsored by 2 or more 
                                employers, the plan is liable for such 
                                penalty; or
                                    ``(II) not so sponsored, the 
                                employer is liable for such penalty.
                    ``(C) Amount of penalty.--
                            ``(i) In general.--The maximum amount of 
                        penalty imposed under this paragraph is $100 
                        for each day for each individual with respect 
                        to which such a failure occurs.
                            ``(ii) Considerations in imposition.--In 
                        determining the amount of any penalty to be 
                        assessed under this paragraph, the Secretary 
                        shall take into account the previous record of 
                        compliance of the entity being assessed with 
                        the applicable provisions of this part and the 
                        gravity of the violation.
                            ``(iii) Limitations.--
                                    ``(I) Penalty not to apply where 
                                failure not discovered exercising 
                                reasonable diligence.--No civil money 
                                penalty shall be imposed under this 
                                paragraph on any failure during any 
                                period for which it is established to 
                                the satisfaction of the Secretary that 
                                none of the entities against whom the 
                                penalty would be imposed knew, or 
                                exercising reasonable diligence would 
                                have known, that such failure existed.
                                    ``(II) Penalty not to apply to 
                                failures corrected within 30 days.--No 
                                civil money penalty shall be imposed 
                                under this paragraph on any failure if 
                                such failure was due to reasonable 
                                cause and not to willful neglect, and 
                                such failure is corrected during the 
                                30-day period beginning on the first 
                                day any of the entities against whom 
                                the penalty would be imposed knew, or 
                                exercising reasonable diligence would 
                                have known, that such failure existed.
                    ``(D) Administrative review.--
                            ``(i) Opportunity for hearing.--The entity 
                        assessed shall be afforded an opportunity for 
                        hearing by the Secretary upon request made 
                        within 30 days after the date of the issuance 
                        of a notice of assessment. In such hearing the 
                        decision shall be made on the record pursuant 
                        to section 554 of title 5, United States Code. 
                        If no hearing is requested, the assessment 
                        shall constitute a final and unappealable 
                        order.
                            ``(ii) Hearing procedure.--If a hearing is 
                        requested, the initial agency decision shall be 
                        made by an administrative law judge, and such 
                        decision shall become the final order unless 
                        the Secretary modifies or vacates the decision. 
                        Notice of intent to modify or vacate the 
                        decision of the administrative law judge shall 
                        be issued to the parties within 30 days after 
                        the date of the decision of the judge. A final 
                        order which takes effect under this paragraph 
                        shall be subject to review only as provided 
                        under subparagraph (E).
                    ``(E) Judicial review.--
                            ``(i) Filing of action for review.--Any 
                        entity against whom an order imposing a civil 
                        money penalty has been entered after an agency 
                        hearing under this paragraph may obtain review 
                        by the United States district court for any 
                        district in which such entity is located or the 
                        United States District Court for the District 
                        of Columbia by filing a notice of appeal in 
                        such court within 30 days from the date of such 
                        order, and simultaneously sending a copy of 
                        such notice by registered mail to the 
                        Secretary.
                            ``(ii) Certification of administrative 
                        record.--The Secretary shall promptly certify 
                        and file in such court the record upon which 
                        the penalty was imposed.
                            ``(iii) Standard for review.--The findings 
                        of the Secretary shall be set aside only if 
                        found to be unsupported by substantial evidence 
                        as provided by section 706(2)(E) of title 5, 
                        United States Code.
                            ``(iv) Appeal.--Any final decision, order, 
                        or judgment of the district court concerning 
                        such review shall be subject to appeal as 
                        provided in chapter 83 of title 28 of such 
                        Code.
                    ``(F) Failure to pay assessment; maintenance of 
                action.--
                            ``(i) Failure to pay assessment.--If any 
                        entity fails to pay an assessment after it has 
                        become a final and unappealable order, or after 
                        the court has entered final judgment in favor 
                        of the Secretary, the Secretary shall refer the 
                        matter to the Attorney General who shall 
                        recover the amount assessed by action in the 
                        appropriate United States district court.
                            ``(ii) Nonreviewability.--In such action 
                        the validity and appropriateness of the final 
                        order imposing the penalty shall not be subject 
                        to review.
                    ``(G) Payment of penalties.--Except as otherwise 
                provided, penalties collected under this paragraph 
                shall be paid to the Secretary (or other officer) 
                imposing the penalty and shall be available without 
                appropriation and until expended for the purpose of 
                enforcing the provisions with respect to which the 
                penalty was imposed.
            ``(3) Enforcement authority relating to genetic 
        discrimination.--
                    ``(A) General rule.--In the cases described in 
                paragraph (1), notwithstanding the provisions of 
                paragraph (2)(C), the succeeding subparagraphs of this 
                paragraph shall apply with respect to an action under 
                this subsection by the Secretary with respect to any 
                failure of a health insurance issuer in connection with 
                a group health plan, to meet the requirements of 
                subsection (a)(1)(F), (b)(3), (c), or (d) of section 
                196 or section 197 or 196(b)(1) with respect to genetic 
                information in connection with the plan.
                    ``(B) Amount.--
                            ``(i) In general.--The amount of the 
                        penalty imposed under this paragraph shall be 
                        $100 for each day in the noncompliance period 
                        with respect to each participant or beneficiary 
                        to whom such failure relates.
                            ``(ii) Noncompliance period.--For purposes 
                        of this paragraph, the term `noncompliance 
                        period' means, with respect to any failure, the 
                        period--
                                    ``(I) beginning on the date such 
                                failure first occurs; and
                                    ``(II) ending on the date the 
                                failure is corrected.
                    ``(C) Minimum penalties where failure discovered.--
                Notwithstanding clauses (i) and (ii) of subparagraph 
                (D):
                            ``(i) In general.--In the case of 1 or more 
                        failures with respect to an individual--
                                    ``(I) which are not corrected 
                                before the date on which the plan 
                                receives a notice from the Secretary of 
                                such violation; and
                                    ``(II) which occurred or continued 
                                during the period involved;
                        the amount of penalty imposed by subparagraph 
                        (A) by reason of such failures with respect to 
                        such individual shall not be less than $2,500.
                            ``(ii) Higher minimum penalty where 
                        violations are more than de minimis.--To the 
                        extent violations for which any person is 
                        liable under this paragraph for any year are 
                        more than de minimis, clause (i) shall be 
                        applied by substituting `$15,000' for `$2,500' 
                        with respect to such person.
                    ``(D) Limitations.--
                            ``(i) Penalty not to apply where failure 
                        not discovered exercising reasonable 
                        diligence.--No penalty shall be imposed by 
                        subparagraph (A) on any failure during any 
                        period for which it is established to the 
                        satisfaction of the Secretary that the person 
                        otherwise liable for such penalty did not know, 
                        and exercising reasonable diligence would not 
                        have known, that such failure existed.
                            ``(ii) Penalty not to apply to failures 
                        corrected within certain periods.--No penalty 
                        shall be imposed by subparagraph (A) on any 
                        failure if--
                                    ``(I) such failure was due to 
                                reasonable cause and not to willful 
                                neglect; and
                                    ``(II) such failure is corrected 
                                during the 30-day period beginning on 
                                the first date the person otherwise 
                                liable for such penalty knew, or 
                                exercising reasonable diligence would 
                                have known, that such failure existed.
                            ``(iii) Overall limitation for 
                        unintentional failures.--In the case of 
                        failures which are due to reasonable cause and 
                        not to willful neglect, the penalty imposed by 
                        subparagraph (A) for failures shall not exceed 
                        the amount equal to the lesser of--
                                    ``(I) 10 percent of the aggregate 
                                amount paid or incurred by the employer 
                                (or predecessor employer) during the 
                                preceding taxable year for group health 
                                plans; or
                                    ``(II) $500,000.
                    ``(E) Waiver by secretary.--In the case of a 
                failure which is due to reasonable cause and not to 
                willful neglect, the Secretary may waive part or all of 
                the penalty imposed by subparagraph (A) to the extent 
                that the payment of such penalty would be excessive 
                relative to the failure involved.
    ``(c) Definitions.--For purposes of this section:
            ``(1) Governmental plan.--The term `governmental plan' has 
        the meaning given such term under section 3(32) of the Employee 
        Retirement Income Security Act of 1974 and any Federal 
        governmental plan.
            ``(2) Federal governmental plan.--The term ``Federal 
        governmental plan'' means a governmental plan established or 
        maintained for its employees by the Government of the United 
        States or by any agency or instrumentality of such Government.
            ``(3) Non-federal governmental plan.--The term `non-Federal 
        governmental plan' means a governmental plan that is not a 
        Federal governmental plan.''.
    (b) Conforming Amendment.--The table of contents under section 1(b) 
of the Health Insurance Portability and Accountability Act of 1996 
(Public Law 104-191) is amended by inserting after the item relating to 
section 195 the following:

``Sec. 196. Guaranteed availability of coverage.
``Sec. 197. Fair health insurance premiums.
``Sec. 198. Prohibiting discrimination against individual participants 
                            and beneficiaries based on health status.
``Sec. 199. Prohibition of preexisting condition exclusions or other 
                            discrimination based on health status.
``Sec. 199A. Enforcement of certain health insurance requirements.''.
    (c) ERISA and IRC Enforcement.--
            (1) ERISA.--Subpart B of part 7 of title I of the Employee 
        Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) 
        is amended by adding at the end the following new section:

``SEC. 716. OTHER MARKET REFORMS.

    ``Sections 196 and 197 of the Health Insurance Portability and 
Accountability Act of 1996 shall apply to health insurance issuers 
providing health insurance coverage in connection with group health 
plans, and sections 198 through 199 of such 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, and to the extent that any provision of this part conflicts 
with a provision of such sections 196 or 197 with respect to health 
insurance issuers providing health insurance coverage in connection 
with group health plans or of such sections 198 or 199 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 196 through 199 shall apply.''.
            (2) IRC.--Subchapter B of chapter 100 of subtitle K of 
        title 26 of the Internal Revenue Code of 1986 is amended by 
        adding at the end the following new section:

``SEC. 9816. OTHER MARKET REFORMS.

    ``Sections 196 and 197 of the Health Insurance Portability and 
Accountability Act of 1996 shall apply to health insurance issuers 
providing health insurance coverage in connection with group health 
plans, and sections 198 through 199 of such 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, and to the extent that any provision of this chapter 
conflicts with a provision of such sections 196 or 197 with respect to 
health insurance issuers providing health insurance coverage in 
connection with group health plans or of such sections 198 or 199 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 196 through 199 shall apply.''.
                                 <all>