Pre-existing Conditions Protection Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 892 To amend the Public Health Service Act to prohibit application of pre- existing condition exclusions and to guarantee availability of health insur- ance coverage in the individual and group market, contingent on the enactment of legislation repealing the Patient Protection and Affordable Care Act, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 5, 2021 Mrs. RODGERS of Washington (for herself, Mr. BILIRAKIS, Mr. MULLIN, Mr. MCKINLEY, Mr. WALBERG, Mr. BURGESS, Mr. CHABOT, Mr. GARCIA of California, Mr. GALLAGHER, Mr. KELLY of Pennsylvania, Mr. PERRY, Mrs. WAGNER, Mr. HERN, Mr. BUCSHON, Mr. UPTON, Mr. HUDSON, Mr. TAYLOR, Mr. GROTHMAN, Mr. AMODEI, Mr. LATTA, Mr. LONG, Mr. ROUZER, Mr. NEWHOUSE, Mr. KINZINGER, Mr. CURTIS, Mr. SMITH of Missouri, Mr. MURPHY of North Carolina, Ms. STEFANIK, Mr. BALDERSON, Mr. BERGMAN, Mrs. HARTZLER, Mr. YOUNG, and Mr. GUTHRIE) introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subse- quently 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 Public Health Service Act to prohibit applica- tion of pre-existing condition exclusions and to guarantee availability of health insurance coverage in the individual and group market, contingent on the enactment of legis- lation repealing the Patient Protection and Affordable Care Act, and for other purposes. VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 892 IH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Pre-existing Conditions 4 Protection Act of 2021’’. 5 SEC. 2. PROHIBITION OF PRE-EXISTING CONDITION EXCLU- 6 SIONS. 7 (a) GROUP MARKET.—Subject to section 6(a) of this 8 Act, subpart 1 of part A of title XXVII of the Public 9 Health Service Act (42 U.S.C. 300gg et seq.), as restored 10 or revived pursuant to PPACA repeal legislation described 11 in section 6(b) of this Act, is amended by striking section 12 2701 and inserting the following: 13 ‘‘SEC. 2701. PROHIBITION OF PRE-EXISTING CONDITION EX- 14 CLUSIONS. 15 ‘‘(a) IN GENERAL.—A group health plan or a health 16 insurance issuer offering group health insurance coverage 17 may not impose any pre-existing condition exclusion with 18 respect to such plan or coverage. 19 ‘‘(b) DEFINITIONS.—For purposes of this section: 20 ‘‘(1) PRE-EXISTING CONDITION EXCLUSION.— 21 ‘‘(A) IN GENERAL.—The term ‘pre-existing 22 condition exclusion’ means, with respect to a 23 group health plan or health insurance coverage, 24 a limitation or exclusion of benefits relating to 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 892 IH a condition based on the fact that the condition 1 was present before the date of enrollment in 2 such plan or for such coverage, whether or not 3 any medical advice, diagnosis, care, or treat- 4 ment was recommended or received before such 5 date. 6 ‘‘(B) TREATMENT OF GENETIC INFORMA- 7 TION.—Genetic information shall not be treated 8 as a pre-existing condition in the absence of a 9 diagnosis of the condition related to such infor- 10 mation. 11 ‘‘(2) DATE OF ENROLLMENT.—The term ‘date 12 of enrollment’ means, with respect to an individual 13 covered under a group health plan or health insur- 14 ance coverage, the date of enrollment of the indi- 15 vidual in the plan or coverage or, if earlier, the first 16 day of the waiting period for such enrollment. 17 ‘‘(3) WAITING PERIOD.—The term ‘waiting pe- 18 riod’ means, with respect to a group health plan and 19 an individual who is a potential participant or bene- 20 ficiary in the plan, the period that must pass with 21 respect to the individual before the individual is eli- 22 gible to be covered for benefits under the terms of 23 the plan.’’. 24 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 892 IH (b) INDIVIDUAL MARKET.—Subject to section 6(a) of 1 this Act, subpart 1 of part B of title XXVII of the Public 2 Health Service Act (42 U.S.C. 300gg–41 et seq.), as re- 3 stored or revived pursuant to PPACA repeal legislation 4 described in section 6(b) of this Act, is amended by adding 5 at the end the following: 6 ‘‘SEC. 2746. PROHIBITION OF PRE-EXISTING CONDITION EX- 7 CLUSIONS OR OTHER DISCRIMINATION 8 BASED ON HEALTH STATUS. 9 ‘‘The provisions of section 2701 shall apply to health 10 insurance coverage offered to individuals by a health in- 11 surance issuer in the individual market in the same man- 12 ner as it applies to health insurance coverage offered by 13 a health insurance issuer in the group market.’’. 14 SEC. 3. GUARANTEED AVAILABILITY OF COVERAGE. 15 (a) GROUP MARKET.—Subject to section 6(a) of this 16 Act, subpart 3 of part A of title XXVII of the Public 17 Health Service Act, as restored or revived pursuant to 18 PPACA repeal legislation described in section 6(b) of this 19 Act, is amended by striking section 2711 (42 U.S.C. 20 300gg–11) and inserting the following: 21 ‘‘SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE. 22 ‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE 23 GROUP MARKET.—Subject to subsection (b), each health 24 insurance issuer that offers health insurance coverage in 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 892 IH the group market in a State shall accept every employer 1 and every individual in a group in the State that applies 2 for such coverage. 3 ‘‘(b) ENROLLMENT.— 4 ‘‘(1) RESTRICTION.—A health insurance issuer 5 described in subsection (a) may restrict enrollment 6 in coverage described in such subsection to open or 7 special enrollment periods. 8 ‘‘(2) ESTABLISHMENT.—A health insurance 9 issuer described in subsection (a) shall establish spe- 10 cial enrollment periods for qualifying events (as such 11 term is defined in section 603 of the Employee Re- 12 tirement Income Security Act of 1974).’’. 13 (b) INDIVIDUAL MARKET.—Subject to section 6(a) of 14 this Act, subpart 1 of part B of title XXVII of the Public 15 Health Service Act, as restored or revived pursuant to 16 PPACA repeal legislation described in section 6(b) of this 17 Act, is amended by striking section 2741 of such Act (42 18 U.S.C. 300gg–41) and inserting the following: 19 ‘‘SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE. 20 ‘‘The provisions of section 2711 shall apply to health 21 insurance coverage offered to individuals by a health in- 22 surance issuer in the individual market in the same man- 23 ner as such provisions apply to health insurance coverage 24 offered to employers by a health insurance issuer in con- 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 892 IH nection with health insurance coverage in the group mar- 1 ket. For purposes of this section, the Secretary shall treat 2 any reference of the word ‘employer’ in such section as 3 a reference to the term ‘individual’.’’. 4 SEC. 4. PROHIBITING DISCRIMINATION AGAINST INDI- 5 VIDUAL PARTICIPANTS AND BENEFICIARIES 6 BASED ON HEALTH STATUS. 7 (a) GROUP MARKET.—Subject to section 6(a) of this 8 Act, section 2702 of the Public Health Service Act, as re- 9 stored or revived pursuant to PPACA repeal legislation 10 described in section 6(b) of this Act, is amended to read 11 as follows: 12 ‘‘SEC. 2702. PROHIBITING DISCRIMINATION AGAINST INDI- 13 VIDUAL PARTICIPANTS AND BENEFICIARIES 14 BASED ON HEALTH STATUS. 15 ‘‘(a) IN GENERAL.—A group health plan and a health 16 insurance issuer offering group health insurance coverage 17 may not establish rules for eligibility (including continued 18 eligibility) of any individual to enroll under the terms of 19 the plan or coverage based on any of the following health 20 status-related factors in relation to the individual or a de- 21 pendent of the individual: 22 ‘‘(1) Health status. 23 ‘‘(2) Medical condition (including both physical 24 and mental illnesses). 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 892 IH ‘‘(3) Claims experience. 1 ‘‘(4) Receipt of health care. 2 ‘‘(5) Medical history. 3 ‘‘(6) Genetic information. 4 ‘‘(7) Evidence of insurability (including condi- 5 tions arising out of acts of domestic violence). 6 ‘‘(8) Disability. 7 ‘‘(9) Any other health status-related factor de- 8 termined appropriate by the Secretary. 9 ‘‘(b) IN PREMIUM CONTRIBUTIONS.— 10 ‘‘(1) IN GENERAL.—A group health plan, and a 11 health insurance issuer offering group health insur- 12 ance coverage, may not require any individual (as a 13 condition of enrollment or continued enrollment 14 under the plan) to pay a premium or contribution 15 which is greater than such premium or contribution 16 for a similarly situated individual enrolled in the 17 plan on the basis of any health status-related factor 18 in relation to the individual or to an individual en- 19 rolled under the plan as a dependent of the indi- 20 vidual. 21 ‘‘(2) CONSTRUCTION.—Nothing in paragraph 22 (1) shall be construed— 23 ‘‘(A) to restrict the amount that an em- 24 ployer or individual may be charged for cov- 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 892 IH erage under a group health plan except as pro- 1 vided in paragraph (3); or 2 ‘‘(B) to prevent a group health plan, and 3 a health insurance issuer offering group health 4 insurance coverage, from establishing premium 5 discounts or rebates or modifying otherwise ap- 6 plicable copayments or deductibles in return for 7 adherence to programs of health promotion and 8 disease prevention. 9 ‘‘(3) NO GROUP-BASED DISCRIMINATION ON 10 BASIS OF GENETIC INFORMATION.— 11 ‘‘(A) IN GENERAL.—For purposes of this 12 section, a group health plan, and health insur- 13 ance issuer offering group health insurance cov- 14 erage, may not adjust premium or contribution 15 amounts for the group covered under such plan 16 on the basis of genetic information. 17 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 18 in subparagraph (A) or in paragraphs (1) and 19 (2) of subsection (d) shall be construed to limit 20 the ability of a health insurance issuer offering 21 group health insurance coverage to increase the 22 premium for an employer based on the mani- 23 festation of a disease or disorder of an indi- 24 vidual who is enrolled in the plan. In such case, 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 892 IH the manifestation of a disease or disorder in 1 one individual cannot also be used as genetic in- 2 formation about other group members and to 3 further increase the premium for the employer. 4 ‘‘(c) GENETIC TESTING.— 5 ‘‘(1) LIMITATION ON REQUESTING OR REQUIR- 6 ING GENETIC TESTING.—A group health plan, and a 7 health insurance issuer offering health insurance 8 coverage in connection with a group health plan, 9 shall not request or require an individual or a family 10 member of such individual to undergo a genetic test. 11 ‘‘(2) RULE OF CONSTRUCTION.—Paragraph (1) 12 shall not be construed to limit the authority of a 13 health care professional who is providing health care 14 services to an individual to request that such indi- 15 vidual undergo a genetic test. 16 ‘‘(3) RULE OF CONSTRUCTION REGARDING PAY- 17 MENT.— 18 ‘‘(A) IN GENERAL.—Nothing in paragraph 19 (1) shall be construed to preclude a group 20 health plan, or a health insurance issuer offer- 21 ing health insurance coverage in connection 22 with a group health plan, from obtaining and 23 using the results of a genetic test in making a 24 determination regarding payment (as such term 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 892 IH is defined for the purposes of applying the regu- 1 lations promulgated by the Secretary under 2 part C of title XI of the Social Security Act and 3 section 264 of the Health Insurance Portability 4 and Accountability Act of 1996, as may be re- 5 vised from time to time) consistent with sub- 6 section (a). 7 ‘‘(B) LIMITATION.—For purposes of sub- 8 paragraph (A), a group health plan, or a health 9 insurance issuer offering health insurance cov- 10 erage in connection with a group health plan, 11 may request only the minimum amount of in- 12 formation necessary to accomplish the intended 13 purpose. 14 ‘‘(4) RESEARCH EXCEPTION.—Notwithstanding 15 paragraph (1), a group health plan, or a health in- 16 surance issuer offering health insurance coverage in 17 connection with a group health plan, may request, 18 but not require, that a participant or beneficiary un- 19 dergo a genetic test if each of the following condi- 20 tions is met: 21 ‘‘(A) The request is made pursuant to re- 22 search that complies with part 46 of title 45, 23 Code of Federal Regulations, or equivalent Fed- 24 eral regulations, and any applicable State or 25 VerDate Sep 11 2014 00:00 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H892.IH H892 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 892 IH local law or regulations for the protection of 1 human subjects in research. 2 ‘‘(B) The plan or issuer clearly indicates to 3 each participant or beneficiary, or in the case of 4 a minor child, to the legal guardian of such 5 beneficiary, to whom the request is made that— 6 ‘‘(i) compliance with the request is 7 voluntary; and 8 ‘‘(ii) non-compliance will have no ef- 9 fect on enrollment status or premium or 10 contribution amounts. 11 ‘‘(C) No genetic information collected or 12 acquired under this paragraph shall be used for 13 underwriting purposes. 14 ‘‘(D) The plan or issuer notifies the Sec- 15 retary in writing that the plan or issuer is con- 16 ducting activities pursuant to the exception pro- 17 vided for under this paragraph, including a de- 18 scription of the activities conducted. 19 ‘‘(E) The plan or issuer complies with such 20 other conditions as the Secretar [Text truncated for display. 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