Health Insurance Lemon Law Act

I 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 Com- mittee 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 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 ‘‘Health Insurance 4 Lemon Law Act’’. 5 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 8875 IH SEC. 2. ESTABLISHMENT OF A SPECIAL ENROLLMENT PE- 1 RIOD FOR ELIGIBLE INDIVIDUALS WHO ARE 2 ENROLLED IN A NON-COMPLIANT HEALTH 3 PLAN. 4 (a) SPECIAL ENROLLMENT PERIODS FOR INDIVID- 5 UALS ENROLLED IN NON-COMPLIANT HEALTH PLANS.— 6 (1) OPTION FOR ELIGIBLE INDIVIDUALS TO EN- 7 ROLL IN EXCHANGE PLANS THROUGH A SPECIAL EN- 8 ROLLMENT PERIOD.—Section 1311(c) of the Patient 9 Protection and Affordable Care Act (42 U.S.C. 10 18031(c)) is amended— 11 (A) in paragraph (6)— 12 (i) in subparagraph (C), by striking at 13 the end ‘‘and’’; 14 (ii) in subparagraph (D), by striking 15 the period at the end and inserting ‘‘; 16 and’’; and 17 (iii) by adding at the end the fol- 18 lowing new subparagraph: 19 ‘‘(E) special enrollment periods described 20 in paragraph (8)(A).’’; and 21 (B) by adding at the end the following new 22 paragraph: 23 ‘‘(8) SPECIAL ENROLLMENT PERIOD FOR INDI- 24 VIDUALS ENROLLED IN NON-COMPLIANT EXCHANGE 25 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 8875 IH PLANS TO ENROLL IN DIFFERENT EXCHANGE 1 PLANS.— 2 ‘‘(A) IN GENERAL.—A special enrollment 3 period described in this subparagraph is, begin- 4 ning 60 days after the date of the enactment of 5 this paragraph, the 60-day period beginning on 6 the date an eligible individual confirms receiv- 7 ing a notification that the health plan in which 8 the eligible individual is enrolled is a non-com- 9 pliant health plan. 10 ‘‘(B) SELF-ATTESTATION.—For purposes 11 of qualifying for the special enrollment period 12 described in subparagraph (A), the receipt of a 13 notification that the health plan in which the el- 14 igible individual is enrolled is a non-compliant 15 health plan shall be determined by the self-at- 16 testation of an eligible individual. 17 ‘‘(C) DEFINITIONS.—In this paragraph: 18 ‘‘(i) ELIGIBLE INDIVIDUAL.— 19 ‘‘(I) IN GENERAL.—The term ‘el- 20 igible individual’ means a qualified in- 21 dividual who is enrolled in a non-com- 22 pliant health plan. 23 ‘‘(II) INCLUSION.—Such term in- 24 cludes a covered employee (as defined 25 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 8875 IH in section 607(2) of the Employee Re- 1 tirement Income Security Act of 2 1974) who is enrolled in a non-compli- 3 ant health plan. 4 ‘‘(ii) NON-COMPLIANT HEALTH 5 PLAN.—The term ‘non-compliant health 6 plan’ means a group health plan or health 7 insurance coverage offered by a health in- 8 surance issuer in the individual or small 9 group market that is not so in compliance 10 (as applicable) with any of— 11 ‘‘(I) sections 2701, 2702, 2703, 12 2704, 2705, 2706, 2708, 2709, 2711, 13 2712, 2713, 2714, 2715, 2716, 2717, 14 2718, 2719, 2719A, 2725, 2726, 15 2727, 2728, or 2794 of the Public 16 Health Service Act; 17 ‘‘(II) sections 1302 or 1312 of 18 the Patient Protection and Affordable 19 Care Act; 20 ‘‘(III) section 105 of the Internal 21 Revenue Code of 1986; or 22 ‘‘(IV) sections 601 through 608 23 of the Employee Retirement Income 24 Security Act of 1974.’’. 25 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 8875 IH (2) OPTION FOR COVERED EMPLOYEES EN- 1 ROLLED IN NON-COMPLIANT GROUP HEALTH PLANS 2 TO ENROLL IN A DIFFERENT GROUP HEALTH 3 PLAN.—Section 701 of the Employee Retirement In- 4 come Security Act (29 U.S.C. 1181) is amended by 5 inserting after paragraph (6) the following new 6 paragraph: 7 ‘‘(7) SPECIAL ENROLLMENT PERIOD FOR COV- 8 ERED EMPLOYEES ENROLLED IN NON-COMPLIANT 9 GROUP HEALTH PLANS TO ENROLL IN A DIFFERENT 10 GROUP HEALTH PLAN.— 11 ‘‘(A) IN GENERAL.—Beginning 60 days 12 after the date of the enactment of this para- 13 graph, a group health plan shall permit an em- 14 ployee who is enrolled in the group health plan 15 that is not in compliance with a requirement 16 specified under clause (C)(ii) of section 17 1311(c)(8) of the Patient Protection and Af- 18 fordable Care Act (as applicable) to enroll in a 19 different group health plan offered by the em- 20 ployer for a 60-day period beginning on the 21 date the employee confirms receiving a notifica- 22 tion that the group health plan in which the 23 employee is not so in compliance. 24 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 8875 IH ‘‘(B) SELF-ATTESTATION.—For purposes 1 of qualifying for the special enrollment period 2 described in subparagraph (A), the receipt of a 3 notification that the group health plan in which 4 the eligible individual is enrolled is a non-com- 5 pliant health plan shall be determined by the 6 self-attestation of an eligible individual.’’. 7 (b) REQUIREMENT FOR FIRST DAY OF COVERAGE 8 FOR ELIGIBLE INDIVIDUALS ENROLLING DURING THE 9 SPECIAL ENROLLMENT PERIOD.— 10 (1) NON-COMPLIANT EXCHANGE PLANS.—Sec- 11 tion 1303 of the Patient Protection and Affordable 12 Care Act (42 U.S.C. 18023) is amended by adding 13 at the end the following new subsection: 14 ‘‘(e) REQUIREMENT FOR FIRST DAY OF COVERAGE 15 FOR ELIGIBLE INDIVIDUALS ENROLLING DURING THE 16 SPECIAL ENROLLMENT PERIOD.— 17 ‘‘(1) NOTIFICATION REQUIREMENT.— 18 ‘‘(A) IN GENERAL.—With respect to health 19 insurance coverage in the individual or small 20 group market group offered by a health insur- 21 ance issuer, any health insurance issuer of such 22 coverage that is not in compliance with a re- 23 quirement specified under clause (C)(ii) of sec- 24 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 8875 IH tion 1311(c)(8) of the Patient Protection and 1 Affordable Care Act shall— 2 ‘‘(i) for the 30-day period beginning 3 on the date the issuer receives a notice 4 from the Secretary of Health and Human 5 Services that such coverage is not so in 6 compliance, attempt to receive confirma- 7 tion that each enrollee of such coverage is 8 eligible for the special enrollment period 9 described in section subparagraph (A) of 10 such section; and 11 ‘‘(ii) not later than 60 days after the 12 date the issuer receives the notice de- 13 scribed in clause (i), in the case the cov- 14 erage does not receive confirmation for an 15 enrollee pursuant to such clause, submit to 16 the Secretary of Health and Human Serv- 17 ices the name of the enrollee and efforts to 18 notify and receive confirmation from the 19 enrollee. 20 ‘‘(B) PRIVACY CONSIDERATIONS.—In car- 21 rying out this paragraph, the health insurance 22 issuer shall take measures to ensure that infor- 23 mation as may be specifically permitted or re- 24 quired under other applicable provisions of law, 25 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 8875 IH including HIPAA privacy and security law as 1 defined in section 3009(a) of the Public Health 2 Service Act (42 U.S.C. 300jj–19(a)) is not 3 made public under this paragraph. 4 ‘‘(2) REQUIREMENT FOR FIRST DAY OF COV- 5 ERAGE.—In the case of an eligible individual (as de- 6 fined in subparagraph (C) of section 1311(c)(8)) 7 who enrolls in a qualified health plan through an 8 Exchange during a month during the special enroll- 9 ment period described in subparagraph (A) of such 10 section— 11 ‘‘(A) coverage under health insurance cov- 12 erage offered a health insurance issuer in the 13 individual or small group market shall termi- 14 nate on the last day of the such month in which 15 the eligible individual so enrolls in the qualified 16 health plan; and 17 ‘‘(B) coverage under the qualified health 18 plan shall be effective beginning on the first day 19 of the first month succeeding the month termi- 20 nation of coverage described in subparagraph 21 (A).’’. 22 (2) NON-COMPLIANT GROUP HEALTH PLANS.— 23 Section 701(7) of the Employee Retirement Income 24 Security Act of 1974 (29 U.S.C. 1181(7)), as 25 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 8875 IH amended by subsection (a)(2), is further amended, 1 by inserting after subparagraph (B) the following 2 new subparagraphs: 3 ‘‘(C) NOTIFICATION REQUIREMENT.— 4 ‘‘(i) IN GENERAL.—A group health 5 plan that is not in compliance with a re- 6 quirement specified under subparagraph 7 (C)(ii) of section 1311(c)(8) of the Patient 8 Protection and Affordable Care Act shall— 9 ‘‘(I) for the 30-day period begin- 10 ning after the date the plan receives a 11 notice from the Secretary of Labor 12 that such plan is not in compliance, 13 attempt to receive confirmation that 14 each enrollee of such plan was so noti- 15 fied of the special enrolled period de- 16 scribed in subparagraph (A) of such 17 section and the special enrollment pe- 18 riod described in subparagraph (A); 19 and 20 ‘‘(II) not later than 60 days after 21 the date the plan receives the notice 22 described in clause (i), in the case the 23 plan does not receive confirmation for 24 an enrollee pursuant to such clause, 25 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 8875 IH submit to the Secretary of Labor the 1 name of the enrollee and efforts to no- 2 tify and receive confirmation from the 3 enrollee. 4 ‘‘(ii) PRIVACY CONSIDERATIONS.—In 5 carrying out this subparagraph, the group 6 health plan shall take measures to ensure 7 that information as may be specifically 8 permitted or required under other applica- 9 ble provisions of law, including HIPAA pri- 10 vacy and security law as defined in section 11 3009(a) of the Public Health Service Act 12 (42 U.S.C. 300jj–19(a)) is not made public 13 under this subparagraph. 14 ‘‘(D) REQUIREMENT FOR FIRST DAY OF 15 COVERAGE.—In the case of an eligible indi- 16 vidual (as defined in subparagraph (C) of sec- 17 tion 1311(c)(8) of the Patient Protection and 18 Affordable Care Act) who is a covered employee 19 and who— 20 ‘‘(i) enrolls in a qualified health plan 21 through an Exchange during a month dur- 22 ing the special enrollment period described 23 in subparagraph (A) of such section— 24 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 8875 IH ‘‘(I) coverage under a group 1 health plan shall terminate on the last 2 day of the such month in which the el- 3 igible individual so enrolls in the 4 qualified health plan; and 5 ‘‘(II) coverage under the qualified 6 health plan shall be determined in ac- 7 cordance with section 1303(e)(2) of 8 such Act; or 9 ‘‘(ii) enrolls in a different group 10 health plan offered by the employer of the 11 covered employee pursuant to the special 12 enrollment period described in subpara- 13 graph (A)— 14 ‘‘(I) coverage under a group 15 health plan shall terminate on the last 16 day of the such month in which the el- 17 igible individual so enrolls in the 18 qualified health plan; and 19 ‘‘(II) coverage under the different 20 group health plan offered by the em- 21 ployer of the qualified beneficiary 22 shall be effective beginning on the 23 first day of the first month succeeding 24 VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 8875 IH the month of termination of coverage 1 described in subclause (I).’’. 2 Æ VerDate Sep 11 2014 19:06 Dec 23, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\H8875.IH H8875 pbinns on DSKJLVW7X2PROD with BILLS