To amend the Public Health Service Act and the Employee Retirement Income Security Act of 1974 to establish certain requirements for managed care plans.
Establishes a Managed Care Consumer Advisory Commission to assist consumers in assessing services, understanding and exercising their rights and responsibilities, and making an informed and appropriate plan choice.
Prohibits managed care plans from limiting coverage, in cases where a plan provides coverage for prescription drugs, if a treating health professional determines such coverage is medically necessary and appropriate. Permits determinations as to whether a drug prescribed to treat a medical condition may be substituted with a different drug to be made only by a treating physician. Bars: (1) plans from providing a standard for substituting prescription drugs; (2) the substitution of a generic drug for a name brand drug unless it has the same chemical composition; and (3) plans that provide prescription drug coverage from limiting access to covered drugs solely on the basis of associated coverage costs.
(Sec. 3) Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require a group health plan (and a health insurance issuer offering group coverage) to comply with the above amendments to the Public Health Service Act. Declares that those requirements do not preempt State laws providing equivalent or stricter protections for individuals.
(Sec. 4) Prohibits construing certain ERISA provisions (relating to preemption of State laws) to preclude any State cause of action for damages for personal injury or wrongful death against any person providing insurance or administrative services to an employee welfare benefit pan maintained to provide health benefits.
Introduced in House
Introduced in House
Referred to the Committee on Commerce, and in addition to the Committee on Education and the Workforce, 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.
Referred to the Committee on Commerce, and in addition to the Committee on Education and the Workforce, 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.
Referred to the Committee on Commerce, and in addition to the Committee on Education and the Workforce, 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.
Referred to the Subcommittee on Health and Environment.
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