Title: Health Insurance Lemon Law Act
Policy area: Health

Summary:
Health Insurance Lemon Law Act  This bill establishes a 60-day special enrollment period for individuals enrolled in health insurance plans that are not in compliance with certain standards of coverage under current law.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8875 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 8875

    To amend the Patient Protection and Affordable Care Act and the 
Employee Retirement Income Security Act of 1974 to establish a special 
  enrollment period for eligible individuals who are enrolled in non-
            compliant health plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 4, 2020

 Mr. Kennedy introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, 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 Patient Protection and Affordable Care Act and the 
Employee Retirement Income Security Act of 1974 to establish a special 
  enrollment period for eligible individuals who are enrolled in non-
            compliant health plans, 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 ``Health Insurance Lemon Law Act''.

SEC. 2. ESTABLISHMENT OF A SPECIAL ENROLLMENT PERIOD FOR ELIGIBLE 
              INDIVIDUALS WHO ARE ENROLLED IN A NON-COMPLIANT HEALTH 
              PLAN.

    (a) Special Enrollment Periods for Individuals Enrolled in Non-
Compliant Health Plans.--
            (1) Option for eligible individuals to enroll in exchange 
        plans through a special enrollment period.--Section 1311(c) of 
        the Patient Protection and Affordable Care Act (42 U.S.C. 
        18031(c)) is amended--
                    (A) in paragraph (6)--
                            (i) in subparagraph (C), by striking at the 
                        end ``and'';
                            (ii) in subparagraph (D), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(E) special enrollment periods described in 
                paragraph (8)(A).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(8) Special enrollment period for individuals enrolled in 
        non-compliant exchange plans to enroll in different exchange 
        plans.--
                    ``(A) In general.--A special enrollment period 
                described in this subparagraph is, beginning 60 days 
                after the date of the enactment of this paragraph, the 
                60-day period beginning on the date an eligible 
                individual confirms receiving a notification that the 
                health plan in which the eligible individual is 
                enrolled is a non-compliant health plan.
                    ``(B) Self-attestation.--For purposes of qualifying 
                for the special enrollment period described in 
                subparagraph (A), the receipt of a notification that 
                the health plan in which the eligible individual is 
                enrolled is a non-compliant health plan shall be 
                determined by the self-attestation of an eligible 
                individual.
                    ``(C) Definitions.--In this paragraph:
                            ``(i) Eligible individual.--
                                    ``(I) In general.--The term 
                                `eligible individual' means a qualified 
                                individual who is enrolled in a non-
                                compliant health plan.
                                    ``(II) Inclusion.--Such term 
                                includes a covered employee (as defined 
                                in section 607(2) of the Employee 
                                Retirement Income Security Act of 1974) 
                                who is enrolled in a non-compliant 
                                health plan.
                            ``(ii) Non-compliant health plan.--The term 
                        `non-compliant health plan' means a group 
                        health plan or health insurance coverage 
                        offered by a health insurance issuer in the 
                        individual or small group market that is not so 
                        in compliance (as applicable) with any of--
                                    ``(I) sections 2701, 2702, 2703, 
                                2704, 2705, 2706, 2708, 2709, 2711, 
                                2712, 2713, 2714, 2715, 2716, 2717, 
                                2718, 2719, 2719A, 2725, 2726, 2727, 
                                2728, or 2794 of the Public Health 
                                Service Act;
                                    ``(II) sections 1302 or 1312 of the 
                                Patient Protection and Affordable Care 
                                Act;
                                    ``(III) section 105 of the Internal 
                                Revenue Code of 1986; or
                                    ``(IV) sections 601 through 608 of 
                                the Employee Retirement Income Security 
                                Act of 1974.''.
            (2) Option for covered employees enrolled in non-compliant 
        group health plans to enroll in a different group health 
        plan.--Section 701 of the Employee Retirement Income Security 
        Act (29 U.S.C. 1181) is amended by inserting after paragraph 
        (6) the following new paragraph:
            ``(7) Special enrollment period for covered employees 
        enrolled in non-compliant group health plans to enroll in a 
        different group health plan.--
                    ``(A) In general.--Beginning 60 days after the date 
                of the enactment of this paragraph, a group health plan 
                shall permit an employee who is enrolled in the group 
                health plan that is not in compliance with a 
                requirement specified under clause (C)(ii) of section 
                1311(c)(8) of the Patient Protection and Affordable 
                Care Act (as applicable) to enroll in a different group 
                health plan offered by the employer for a 60-day period 
                beginning on the date the employee confirms receiving a 
                notification that the group health plan in which the 
                employee is not so in compliance.
                    ``(B) Self-attestation.--For purposes of qualifying 
                for the special enrollment period described in 
                subparagraph (A), the receipt of a notification that 
                the group health plan in which the eligible individual 
                is enrolled is a non-compliant health plan shall be 
                determined by the self-attestation of an eligible 
                individual.''.
    (b) Requirement for First Day of Coverage for Eligible Individuals 
Enrolling During the Special Enrollment Period.--
            (1) Non-compliant exchange plans.--Section 1303 of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18023) is 
        amended by adding at the end the following new subsection:
    ``(e) Requirement for First Day of Coverage for Eligible 
Individuals Enrolling During the Special Enrollment Period.--
            ``(1) Notification requirement.--
                    ``(A) In general.--With respect to health insurance 
                coverage in the individual or small group market group 
                offered by a health insurance issuer, any health 
                insurance issuer of such coverage that is not in 
                compliance with a requirement specified under clause 
                (C)(ii) of section 1311(c)(8) of the Patient Protection 
                and Affordable Care Act shall--
                            ``(i) for the 30-day period beginning on 
                        the date the issuer receives a notice from the 
                        Secretary of Health and Human Services that 
                        such coverage is not so in compliance, attempt 
                        to receive confirmation that each enrollee of 
                        such coverage is eligible for the special 
                        enrollment period described in section 
                        subparagraph (A) of such section; and
                            ``(ii) not later than 60 days after the 
                        date the issuer receives the notice described 
                        in clause (i), in the case the coverage does 
                        not receive confirmation for an enrollee 
                        pursuant to such clause, submit to the 
                        Secretary of Health and Human Services the name 
                        of the enrollee and efforts to notify and 
                        receive confirmation from the enrollee.
                    ``(B) Privacy considerations.--In carrying out this 
                paragraph, the health insurance issuer shall take 
                measures to ensure that information as may be 
                specifically permitted or required under other 
                applicable provisions of law, including HIPAA privacy 
                and security law as defined in section 3009(a) of the 
                Public Health Service Act (42 U.S.C. 300jj-19(a)) is 
                not made public under this paragraph.
            ``(2) Requirement for first day of coverage.--In the case 
        of an eligible individual (as defined in subparagraph (C) of 
        section 1311(c)(8)) who enrolls in a qualified health plan 
        through an Exchange during a month during the special 
        enrollment period described in subparagraph (A) of such 
        section--
                    ``(A) coverage under health insurance coverage 
                offered a health insurance issuer in the individual or 
                small group market shall terminate on the last day of 
                the such month in which the eligible individual so 
                enrolls in the qualified health plan; and
                    ``(B) coverage under the qualified health plan 
                shall be effective beginning on the first day of the 
                first month succeeding the month termination of 
                coverage described in subparagraph (A).''.
            (2) Non-compliant group health plans.--Section 701(7) of 
        the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1181(7)), as amended by subsection (a)(2), is further amended, 
        by inserting after subparagraph (B) the following new 
        subparagraphs:
                    ``(C) Notification requirement.--
                            ``(i) In general.--A group health plan that 
                        is not in compliance with a requirement 
                        specified under subparagraph (C)(ii) of section 
                        1311(c)(8) of the Patient Protection and 
                        Affordable Care Act shall--
                                    ``(I) for the 30-day period 
                                beginning after the date the plan 
                                receives a notice from the Secretary of 
                                Labor that such plan is not in 
                                compliance, attempt to receive 
                                confirmation that each enrollee of such 
                                plan was so notified of the special 
                                enrolled period described in 
                                subparagraph (A) of such section and 
                                the special enrollment period described 
                                in subparagraph (A); and
                                    ``(II) not later than 60 days after 
                                the date the plan receives the notice 
                                described in clause (i), in the case 
                                the plan does not receive confirmation 
                                for an enrollee pursuant to such 
                                clause, submit to the Secretary of 
                                Labor the name of the enrollee and 
                                efforts to notify and receive 
                                confirmation from the enrollee.
                            ``(ii) Privacy considerations.--In carrying 
                        out this subparagraph, the group health plan 
                        shall take measures to ensure that information 
                        as may be specifically permitted or required 
                        under other applicable provisions of law, 
                        including HIPAA privacy and security law as 
                        defined in section 3009(a) of the Public Health 
                        Service Act (42 U.S.C. 300jj-19(a)) is not made 
                        public under this subparagraph.
                    ``(D) Requirement for first day of coverage.--In 
                the case of an eligible individual (as defined in 
                subparagraph (C) of section 1311(c)(8) of the Patient 
                Protection and Affordable Care Act) who is a covered 
                employee and who--
                            ``(i) enrolls in a qualified health plan 
                        through an Exchange during a month during the 
                        special enrollment period described in 
                        subparagraph (A) of such section--
                                    ``(I) coverage under a group health 
                                plan shall terminate on the last day of 
                                the such month in which the eligible 
                                individual so enrolls in the qualified 
                                health plan; and
                                    ``(II) coverage under the qualified 
                                health plan shall be determined in 
                                accordance with section 1303(e)(2) of 
                                such Act; or
                            ``(ii) enrolls in a different group health 
                        plan offered by the employer of the covered 
                        employee pursuant to the special enrollment 
                        period described in subparagraph (A)--
                                    ``(I) coverage under a group health 
                                plan shall terminate on the last day of 
                                the such month in which the eligible 
                                individual so enrolls in the qualified 
                                health plan; and
                                    ``(II) coverage under the different 
                                group health plan offered by the 
                                employer of the qualified beneficiary 
                                shall be effective beginning on the 
                                first day of the first month succeeding 
                                the month of termination of coverage 
                                described in subclause (I).''.
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