I 116TH CONGRESS 1ST SESSION H. R. 692 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 JANUARY 18, 2019 Mr. WALDEN introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on Education and Labor, and Ways and Means, 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. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 2 •HR 692 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Pre-existing Conditions 2 Protection Act of 2019’’. 3 SEC. 2. PROHIBITION OF PRE-EXISTING CONDITION EXCLU- 4 SIONS. 5 (a) GROUP MARKET.—Subject to section 6(a) of this 6 Act, subpart 1 of part A of title XXVII of the Public 7 Health Service Act (42 U.S.C. 300gg et seq.), as restored 8 or revived pursuant to PPACA repeal legislation described 9 in section 6(b) of this Act, is amended by striking section 10 2701 and inserting the following: 11 ‘‘SEC. 2701. PROHIBITION OF PRE-EXISTING CONDITION EX- 12 CLUSIONS. 13 ‘‘(a) IN GENERAL.—A group health plan or a health 14 insurance issuer offering group health insurance coverage 15 may not impose any pre-existing condition exclusion with 16 respect to such plan or coverage. 17 ‘‘(b) DEFINITIONS.—For purposes of this section: 18 ‘‘(1) PRE-EXISTING CONDITION EXCLUSION.— 19 ‘‘(A) IN GENERAL.—The term ‘pre-existing 20 condition exclusion’ means, with respect to a 21 group health plan or health insurance coverage, 22 a limitation or exclusion of benefits relating to 23 a condition based on the fact that the condition 24 was present before the date of enrollment in 25 such plan or for such coverage, whether or not 26 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 3 •HR 692 IH any medical advice, diagnosis, care, or treat- 1 ment was recommended or received before such 2 date. 3 ‘‘(B) TREATMENT OF GENETIC INFORMA- 4 TION.—Genetic information shall not be treated 5 as a pre-existing condition in the absence of a 6 diagnosis of the condition related to such infor- 7 mation. 8 ‘‘(2) DATE OF ENROLLMENT.—The term ‘date 9 of enrollment’ means, with respect to an individual 10 covered under a group health plan or health insur- 11 ance coverage, the date of enrollment of the indi- 12 vidual in the plan or coverage or, if earlier, the first 13 day of the waiting period for such enrollment. 14 ‘‘(3) WAITING PERIOD.—The term ‘waiting pe- 15 riod’ means, with respect to a group health plan and 16 an individual who is a potential participant or bene- 17 ficiary in the plan, the period that must pass with 18 respect to the individual before the individual is eli- 19 gible to be covered for benefits under the terms of 20 the plan.’’. 21 (b) INDIVIDUAL MARKET.—Subject to section 6(a) of 22 this Act, subpart 1 of part B of title XXVII of the Public 23 Health Service Act (42 U.S.C. 300gg–41 et seq.), as re- 24 stored or revived pursuant to PPACA repeal legislation 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 4 •HR 692 IH described in section 6(b) of this Act, is amended by adding 1 at the end the following: 2 ‘‘SEC. 2746. PROHIBITION OF PRE-EXISTING CONDITION EX- 3 CLUSIONS OR OTHER DISCRIMINATION 4 BASED ON HEALTH STATUS. 5 ‘‘The provisions of section 2701 shall apply to health 6 insurance coverage offered to individuals by a health in- 7 surance issuer in the individual market in the same man- 8 ner as it applies to health insurance coverage offered by 9 a health insurance issuer in the group market.’’. 10 SEC. 3. GUARANTEED AVAILABILITY OF COVERAGE. 11 (a) GROUP MARKET.—Subject to section 6(a) of this 12 Act, subpart 3 of part A of title XXVII of the Public 13 Health Service Act, as restored or revived pursuant to 14 PPACA repeal legislation described in section 6(b) of this 15 Act, is amended by striking section 2711 (42 U.S.C. 16 300gg–11) and inserting the following: 17 ‘‘SEC. 2711. GUARANTEED AVAILABILITY OF COVERAGE. 18 ‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE 19 GROUP MARKET.—Subject to subsection (b), each health 20 insurance issuer that offers health insurance coverage in 21 the group market in a State shall accept every employer 22 and every individual in a group in the State that applies 23 for such coverage. 24 ‘‘(b) ENROLLMENT.— 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 5 •HR 692 IH ‘‘(1) RESTRICTION.—A health insurance issuer 1 described in subsection (a) may restrict enrollment 2 in coverage described in such subsection to open or 3 special enrollment periods. 4 ‘‘(2) ESTABLISHMENT.—A health insurance 5 issuer described in subsection (a) shall establish spe- 6 cial enrollment periods for qualifying events (as such 7 term is defined in section 603 of the Employee Re- 8 tirement Income Security Act of 1974).’’. 9 (b) INDIVIDUAL MARKET.—Subject to section 6(a) of 10 this Act, subpart 1 of part B of title XXVII of the Public 11 Health Service Act, as restored or revived pursuant to 12 PPACA repeal legislation described in section 6(b) of this 13 Act, is amended by striking section 2741 of such Act (42 14 U.S.C. 300gg–41) and inserting the following: 15 ‘‘SEC. 2741. GUARANTEED AVAILABILITY OF COVERAGE. 16 ‘‘The provisions of section 2711 shall apply to health 17 insurance coverage offered to individuals by a health in- 18 surance issuer in the individual market in the same man- 19 ner as such provisions apply to health insurance coverage 20 offered to employers by a health insurance issuer in con- 21 nection with health insurance coverage in the group mar- 22 ket. For purposes of this section, the Secretary shall treat 23 any reference of the word ‘employer’ in such section as 24 a reference to the term ‘individual’.’’. 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 6 •HR 692 IH SEC. 4. PROHIBITING DISCRIMINATION AGAINST INDI- 1 VIDUAL PARTICIPANTS AND BENEFICIARIES 2 BASED ON HEALTH STATUS. 3 (a) GROUP MARKET.—Subject to section 6(a) of this 4 Act, section 2702 of the Public Health Service Act, as re- 5 stored or revived pursuant to PPACA repeal legislation 6 described in section 6(b) of this Act, is amended to read 7 as follows: 8 ‘‘SEC. 2702. PROHIBITING DISCRIMINATION AGAINST INDI- 9 VIDUAL PARTICIPANTS AND BENEFICIARIES 10 BASED ON HEALTH STATUS. 11 ‘‘(a) IN GENERAL.—A group health plan and a health 12 insurance issuer offering group health insurance coverage 13 may not establish rules for eligibility (including continued 14 eligibility) of any individual to enroll under the terms of 15 the plan or coverage based on any of the following health 16 status-related factors in relation to the individual or a de- 17 pendent of the individual: 18 ‘‘(1) Health status. 19 ‘‘(2) Medical condition (including both physical 20 and mental illnesses). 21 ‘‘(3) Claims experience. 22 ‘‘(4) Receipt of health care. 23 ‘‘(5) Medical history. 24 ‘‘(6) Genetic information. 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 7 •HR 692 IH ‘‘(7) Evidence of insurability (including condi- 1 tions arising out of acts of domestic violence). 2 ‘‘(8) Disability. 3 ‘‘(9) Any other health status-related factor de- 4 termined appropriate by the Secretary. 5 ‘‘(b) IN PREMIUM CONTRIBUTIONS.— 6 ‘‘(1) IN GENERAL.—A group health plan, and a 7 health insurance issuer offering group health insur- 8 ance coverage, may not require any individual (as a 9 condition of enrollment or continued enrollment 10 under the plan) to pay a premium or contribution 11 which is greater than such premium or contribution 12 for a similarly situated individual enrolled in the 13 plan on the basis of any health status-related factor 14 in relation to the individual or to an individual en- 15 rolled under the plan as a dependent of the indi- 16 vidual. 17 ‘‘(2) CONSTRUCTION.—Nothing in paragraph 18 (1) shall be construed— 19 ‘‘(A) to restrict the amount that an em- 20 ployer or individual may be charged for cov- 21 erage under a group health plan except as pro- 22 vided in paragraph (3); or 23 ‘‘(B) to prevent a group health plan, and 24 a health insurance issuer offering group health 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 8 •HR 692 IH insurance coverage, from establishing premium 1 discounts or rebates or modifying otherwise ap- 2 plicable copayments or deductibles in return for 3 adherence to programs of health promotion and 4 disease prevention. 5 ‘‘(3) NO GROUP-BASED DISCRIMINATION ON 6 BASIS OF GENETIC INFORMATION.— 7 ‘‘(A) IN GENERAL.—For purposes of this 8 section, a group health plan, and health insur- 9 ance issuer offering group health insurance cov- 10 erage, may not adjust premium or contribution 11 amounts for the group covered under such plan 12 on the basis of genetic information. 13 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 14 in subparagraph (A) or in paragraphs (1) and 15 (2) of subsection (d) shall be construed to limit 16 the ability of a health insurance issuer offering 17 group health insurance coverage to increase the 18 premium for an employer based on the mani- 19 festation of a disease or disorder of an indi- 20 vidual who is enrolled in the plan. In such case, 21 the manifestation of a disease or disorder in 22 one individual cannot also be used as genetic in- 23 formation about other group members and to 24 further increase the premium for the employer. 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 9 •HR 692 IH ‘‘(c) GENETIC TESTING.— 1 ‘‘(1) LIMITATION ON REQUESTING OR REQUIR- 2 ING GENETIC TESTING.—A group health plan, and a 3 health insurance issuer offering health insurance 4 coverage in connection with a group health plan, 5 shall not request or require an individual or a family 6 member of such individual to undergo a genetic test. 7 ‘‘(2) RULE OF CONSTRUCTION.—Paragraph (1) 8 shall not be construed to limit the authority of a 9 health care professional who is providing health care 10 services to an individual to request that such indi- 11 vidual undergo a genetic test. 12 ‘‘(3) RULE OF CONSTRUCTION REGARDING PAY- 13 MENT.— 14 ‘‘(A) IN GENERAL.—Nothing in paragraph 15 (1) shall be construed to preclude a group 16 health plan, or a health insurance issuer offer- 17 ing health insurance coverage in connection 18 with a group health plan, from obtaining and 19 using the results of a genetic test in making a 20 determination regarding payment (as such term 21 is defined for the purposes of applying the regu- 22 lations promulgated by the Secretary under 23 part C of title XI of the Social Security Act and 24 section 264 of the Health Insurance Portability 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 10 •HR 692 IH and Accountability Act of 1996, as may be re- 1 vised from time to time) consistent with sub- 2 section (a). 3 ‘‘(B) LIMITATION.—For purposes of sub- 4 paragraph (A), a group health plan, or a health 5 insurance issuer offering health insurance cov- 6 erage in connection with a group health plan, 7 may request only the minimum amount of in- 8 formation necessary to accomplish the intended 9 purpose. 10 ‘‘(4) RESEARCH EXCEPTION.—Notwithstanding 11 paragraph (1), a group health plan, or a health in- 12 surance issuer offering health insurance coverage in 13 connection with a group health plan, may request, 14 but not require, that a participant or beneficiary un- 15 dergo a genetic test if each of the following condi- 16 tions is met: 17 ‘‘(A) The request is made pursuant to re- 18 search that complies with part 46 of title 45, 19 Code of Federal Regulations, or equivalent Fed- 20 eral regulations, and any applicable State or 21 local law or regulations for the protection of 22 human subjects in research. 23 ‘‘(B) The plan or issuer clearly indicates to 24 each participant or beneficiary, or in the case of 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 11 •HR 692 IH a minor child, to the legal guardian of such 1 beneficiary, to whom the request is made that— 2 ‘‘(i) compliance with the request is 3 voluntary; and 4 ‘‘(ii) non-compliance will have no ef- 5 fect on enrollment status or premium or 6 contribution amounts. 7 ‘‘(C) No genetic information collected or 8 acquired under this paragraph shall be used for 9 underwriting purposes. 10 ‘‘(D) The plan or issuer notifies the Sec- 11 retary in writing that the plan or issuer is con- 12 ducting activities pursuant to the exception pro- 13 vided for under this paragraph, including a de- 14 scription of the activities conducted. 15 ‘‘(E) The plan or issuer complies with such 16 other conditions as the Secretary may by regu- 17 lation require for activities conducted under this 18 paragraph. 19 ‘‘(d) PROHIBITION ON COLLECTION OF GENETIC IN- 20 FORMATION.— 21 ‘‘(1) IN GENERAL.—A group health plan, and a 22 health insurance issuer offering health insurance 23 coverage in connection with a group health plan, 24 shall not request, require, or purchase genetic infor- 25 VerDate Sep 11 2014 04:18 Jan 31, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H692.IH H692 kjohnson on DSK79L0C42 with BILLS 12 •HR 692 IH mation for underwri [Text truncated for display. 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