Federal Health Insurance Equity Act of 1989

Federal Health Insurance Equity Act of 1989 - Directs the Secretary of Health and Human Services to establish by rule national minimum standards regarding the provision of health insurance to persons with pre-existing conditions. Describes elements required to be included.

Requires that, within 24 months of establishment of the standards and notwithstanding other laws: (1) each sponsor of a health benefit plan comply with the standards; and (2) each State adopt the standards and assume responsibility for enforcing them through assessment of penalties. Requires States to notify the Secretary when they have done so and the Secretary to certify that they have adopted the standards and assumed such responsibility. Prohibits the Secretary, in the case of a State that must enact legislation in order to adopt and assume responsibility for enforcing the standards, from refusing to certify a State before the close of the first regular session of the State legislature that begins after establishment of the standards. Directs the Secretary to withdraw a State's certification for stated reasons.

Provides, with regard to a sponsor who does not comply with the standards, for civil monetary penalties, subject to exception, and for liability to individuals for damages.

 
HR 2649 SC
101st CONGRESS
2d Session
 H. R. 2649
To direct the Secretary of Health and Human Services to promulgate national
standards regarding the provision of health insurance to individuals with
pre-existing conditions, to require States to adopt such standards or equally
effective laws, rules, or regulations, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
June 14, 1989
Mr. WALGREN introduced the following bill; which was referred to the Committee
on Energy and Commerce
July 19, 1990
Additional sponsors: Mr. ROE, Mr. DE LUGO, Mrs. BOXER, Mr. KOLTER, Mr. BATES,
Mr. MCDERMOTT, Mr. DYMALLY, Ms. KAPTUR, Mr. EVANS, Ms. PELOSI, Mr. HUCKABY,
Mr. FOGLIETTA, Mr. PAYNE of New Jersey, Mr. SHAYS, Mr. HAYES of Louisiana,
Mr. SMITH of New Jersey, Mr. WISE, and Mr. Ravenel
A BILL
To direct the Secretary of Health and Human Services to promulgate national
standards regarding the provision of health insurance to individuals with
pre-existing conditions, to require States to adopt such standards or equally
effective laws, rules, or regulations, 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 `Federal Health Insurance Equity Act of 1989'.
SEC. 2. PROMULGATION OF NATIONAL STANDARDS.
  (a) IN GENERAL- Not later than 18 months after the date of the enactment of
  this Act, the Secretary of Health and Human Services shall, in accordance
  with section 553 of title 5, United States Code, promulgate national
  minimum standards regarding the provision of health insurance to persons
  with pre-existing conditions.
  (b) DESCRIPTION OF STANDARDS- (1) The national minimum standards referred
  to in subsection (a) shall include provisions--
  (A) establishing standards for providing basic items and services for which
  payment shall be made at a reasonable cost under a health benefit plan,
  based upon the most recent available medical and financial data;
  (B) establishing standards for the amount of premiums, deductibles,
  copayments, and coinsurance which may be assessed under a health benefit
  plan, based upon the most recent available medical and financial data;
  (C) prohibiting the sponsor of a health benefit plan from excluding,
  terminating, or otherwise limiting any individual from coverage under the
  plan on the basis that the individual has a pre-existing condition; and
  (D) prohibiting the sponsor of a health benefit plan from determining
  the amount of any premium, deductible, copayment, or coinsurance for an
  individual or group of individuals on the basis of the number or amount
  of claims submitted by such individual or individuals.
  (2) The national minimum standards referred to in subsection (a) may
  not include provisions prohibiting the sponsor of a health benefit plan
  from establishing uniform eligibility requirements, applicable to all plan
  participants, regarding minimum waiting periods, minimum enrollment periods,
  or open enrollment periods.
SEC. 3. COMPLIANCE WITH STANDARDS BY SPONSORS; ADOPTION OF STANDARDS BY STATES.
  (a) IN GENERAL- Not later than 24 months after the promulgation of the
  national minimum standards for the provision of health insurance described
  in section 2 and notwithstanding any other provision of law, each sponsor
  of a health benefit plan shall comply with, and each State shall adopt, and
  assume responsibility for enforcing through the assessment of appropriate
  penalties for non-compliance, such national minimum standards. Each State
  shall submit evidence to the Secretary demonstrating that the State has
  so adopted, and assumed responsibility for enforcing, such standards.
  (b) CERTIFICATION BY SECRETARY- (1) Not later than 6 months after receiving
  evidence from a State under subsection (a), the Secretary shall certify
  that the State has adopted, and assumed responsibility for enforcing,
  the national minimum standards promulgated under section 2 if, to the
  satisfaction of the Secretary, the State--
  (A) demonstrates that it has incorporated such minimum standards in its own
  law or has otherwise adopted laws, rules, regulations, and standards which
  ensure, at least as effectively as such minimum standards, the provision
  of adequate health insurance to individuals in the State at a fair and
  reasonable cost regardless of pre-existing conditions; and
  (B) demonstrates that it has established an office to investigate complaints
  that a sponsor of a health benefit plan is not in compliance with State
  law and to provide the public with information and assistance on matters
  relating to health benefits coverage.
  (2) In the case of a State which the Secretary determines must enact
  legislation (other than legislation appropriating funds) in order to adopt,
  and assume responsibility for enforcing, the national minimum standards
  promulgated under section 2, the Secretary may not refuse to certify the
  State solely on the basis of its failure to adopt, and assume responsibility
  for enforcing, such standards before the close of the first regular session
  of the State legislature that begins after the date of the promulgation
  of the standards described in section 2. For purposes of the preceding
  sentence, in the case of a State that has a 2-year legislative session,
  each year of such session shall be deemed to be a separate regular session
  of the State legislature.
  (c) WITHDRAWAL- If the Secretary finds, after affording appropriate notice
  and opportunity for comment, that a certified State is not adequately
  enforcing its laws relating to the provision of health insurance to
  individuals in the State regardless of pre-existing conditions, or that those
  laws, rules, regulations, and standards no longer promote the objectives
  of this Act as effectively as the national minimum standards promulgated
  under section 2, the Secretary shall withdraw the State's certification.
SEC. 4. ENFORCEMENT PROVISIONS.
  (a) FEDERAL SANCTIONS-
  (1) CIVIL MONEY PENALTY- (A) Any sponsor of a health benefit plan which does
  not comply with the national minimum standards promulgated under section
  2 shall be liable to the United States for a civil penalty, assessed by
  an order issued by the Secretary, of $100 per each individual enrolled in
  such plan for each day the sponsor does not comply with such standards.
  (B) The Secretary may, on the basis of mitigating factors, compromise,
  modify, or remit, with or without conditions, any civil penalty assessed
  pursuant to subparagraph (A).
  (C) If the Secretary issues an order pursuant to subparagraph (A), the
  sponsor who is the subject of the order may, before the expiration of the
  30-day period beginning on the date the order is issued, seek judicial
  review of the order pursuant to section 1331 of title 28, United States
  Code, and chapter 7 of title 5, United States Code.
  (D) If a sponsor does not seek judicial review pursuant to subparagraph (C),
  the Secretary may commence a civil action in any appropriate district court
  of the United States for the purposes of recovering the amount assessed and
  an amount representing interest at a rate computed in accordance with section
  1961 of title 28, United States Code. Such interest shall accrue from the
  expiration of the 30-day period described in subpargraph (C). In such an
  action, the decision of the Secretary to issue the order, and the amount
  of the penalty assessed by the Secretary, shall not be subject to review.
  (2) LIABILITY TO INDIVIDUALS FOR DAMAGES- Any sponsor of a health benefit
  plan which does not comply with the national minimum standards promulgated
  under section 2 shall be liable for damages (including health care costs
  incurred) to an individual covered under the plan or the individual's
  family resulting from such failure to comply.
  (3) EFFECTIVE DATE- The provisions of this subsection shall take effect
  30 months after the promulgation of the national minimum health insurance
  standards under section 2.
  (b) NON-APPLICATION OF CIVIL MONEY PENALTY TO CERTAIN SPONSORS- The
  sanctions described in subsection (a)(1) shall not apply with respect to
  sponsors of health benefit plans--
  (1) who are subject to the insurance laws, rules, or regulations of a
  certified State; or
  (2) who are found to be in compliance with the national minimum health
  insurance standards promulgated under section 2 by an entity designated
  by the Secretary to monitor sponsor compliance with such standards for a
  State that is not a certified State.
SEC. 5. DEFINITIONS.
  In this Act:
  (1) The term `certified State' means a State that the Secretary,
  in accordance with section 3(b), certifies has adopted, and assumed
  responsibility for enforcing, the national minimum health insurance
  standards promulgated under section 2.
  (2) The term `health benefit plan' means any plan, fund, or program that
  provides medical care to participants or beneficiaries directly or through
  insurance, reimbursement, or otherwise.
  (3) The term `pre-existing condition' means any disease, disability,
  disorder, impairment, or other health condition.
  (4) The term `Secretary' means the Secretary of Health and Human Services.
  (5) The term `sponsor' means any entity in a State providing a health
  benefit plan in a State.
  (6) The term `State' means any of the several States, the District of
  Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam,
  American Samoa, and the Trust Territory of the Pacific Islands.