H.R.6147 - Group Health Plan Nondiscrimination Act of 1992102nd Congress (1991-1992)
|Sponsor:||Rep. Hughes, William J. [D-NJ-2] (Introduced 10/05/1992)|
|Committees:||House - Education and Labor|
|Latest Action:||House - 10/09/1992 Referred to the Subcommittee on Labor-Management Relations. (All Actions)|
This bill has the status Introduced
Here are the steps for Status of Legislation:
Text: H.R.6147 — 102nd Congress (1991-1992)All Information (Except Text)
There is one version of the bill.
Text available as:
- Bill and resolution texts for 1989-1992 (101st-102nd Congresses) predate authenticated digital publishing.
Introduced in House
HR 6147 IH 102d CONGRESS 2d Session H. R. 6147 To amend title I of the Employee Retirement Income Security Act of 1974 to provide that unreasonable discrimination in benefits under group health plans affecting benefit claims thereunder constitutes interference with rights protected under such Act and to provide for effective remedies therefor, and to provide for adequate notice of material changes to group health plans. IN THE HOUSE OF REPRESENTATIVES October 5, 1992 Mr. HUGHES (for himself and Mr. BOEHLERT) introduced the following bill; which was referred to the Committee on Education and Labor A BILL To amend title I of the Employee Retirement Income Security Act of 1974 to provide that unreasonable discrimination in benefits under group health plans affecting benefit claims thereunder constitutes interference with rights protected under such Act and to provide for effective remedies therefor, and to provide for adequate notice of material changes to group health plans. 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 `Group Health Plan Nondiscrimination Act of 1992'. SEC. 2. PROTECTION FROM INTERFERENCE WITH RIGHTS. Section 510 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1140) is amended-- (1) by inserting `(a) IN GENERAL- ' after `SEC. 510.'; and (2) by adding at the end the following new subsection: `(b) DISCRIMINATION BASED ON BENEFIT CLAIMS UNDER GROUP HEALTH PLANS- `(1) IN GENERAL- In any case in which a plan sponsor adopts a change in group health plan coverage, the adoption of such change shall be deemed a form of discrimination prohibited under subsection (a) if-- `(A) the adoption of such change occurs after submission of a claim under a group health plan maintained by the plan sponsor for provision of, or reimbursement for, a course of treatment which was medically necessary, and `(B) after such change takes effect, the value of benefits provided to the claimant under the group health plan coverage in the form of provision of, or reimbursement for, such course of treatment is reduced or eliminated. `(2) EXCEPTIONS- Paragraph (1) shall not apply with respect to any claimant in the case of the adoption of any change in group health plan coverage if-- `(A) the plan is unable to pay benefits when due, and, but for the adoption of such change, will be terminated, and `(B) there is no reasonable, nondiscriminatory alternative change within the plan sponsor's control. `(3) GROUP HEALTH PLAN- For purposes of this subsection, the term `group health plan' has the meaning provided in section 607(1). SEC. 3. LEGAL RELIEF FROM DAMAGES FOR INTERFERENCE WITH RIGHTS UNDER PLAN. (a) DAMAGES- Section 502(c) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1132(c)) is amended by adding at the end the following new paragraph: `(4)(A) Any person who violates section 510 with respect to any participant or beneficiary under a group health plan shall be liable to such participant or beneficiary for actual damages (including compensatory and consequential damages proximately caused by the violation), except that, subject to subparagraph (B), damages for such violation shall not include punitive damages. `(B) In any case in which the violation constitutes willful, fraudulent, or malicious conduct, bad faith, or gross negligence, each person liable under subparagraph (A) may, in the court's discretion, be liable to the such participant or beneficiary for exemplary damages equal to not more than the greater of-- `(i) 100 percent of the amount of actual damages awarded, or `(ii) $10,000. `(C) For purposes of this paragraph, the term `group health plan' has the meaning provided in section 607(1).'. (b) ATTORNEY'S FEES- Section 502(g) of such Act (29 U.S.C. 1132(g)) is amended by adding at the end the following new paragraph: `(3) In any action for damages under subsection (c)(4) in which the plaintiff prevails or substantially prevails, the court shall award the plaintiff reasonable attorney's fees and other costs of the action, including reasonable expert witness fees and costs, to be paid by the defendant. Fees awarded under this paragraph shall be at generally prevailing hourly rates.'. SEC. 4. REPORTING AND DISCLOSURE REQUIREMENTS. Section 101 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1021) is amended-- (1) by redesignating subsection (f) as subsection (g); and (2) by inserting after subsection (e) the following new subsection: `(f) NOTICE OF MATERIAL CHANGES IN TERMS OF GROUP HEALTH PLANS- `(1) IN GENERAL- A group health plan shall issue to each participant and beneficiary, in language calculated to be easily understood by the typical participant or beneficiary, a notice of any material change in the terms of the plan. `(2) TIME FOR DISCLOSURE- The notice referred to in paragraph (1) shall be issued to each participant and beneficiary not later than 10 days before the adoption of the material change involved. Any material change may not take effect until 60 days after the issuance of such notice. `(3) SPECIAL REQUIREMENTS FOR SELF-INSURED PLANS- In the case of a self-insured group health plan, any notice issued pursuant to this section shall include a statement-- `(A) indicating that the plan is a self-insured health plan and is not a policy of insurance, `(B) indicating that the plan is not subject to State guarantee fund protection, `(C) identifying the person who is responsible for claim determinations and processing, and `(D) indicating that, if the plan does not pay all benefits for which participants or beneficiaries are eligible under the plan, responsibility for payment for medical care may to some extent remain with the participant or beneficiary. `(4) DEFINITIONS- For purposes of this subsection-- `(A) GROUP HEALTH PLAN- The term `group health plan' has the meaning provided in section 607(1). `(B) SELF-INSURED PLANS- A group health plan is `self-insured' unless all benefits provided under the plan are provided under a contract or policy of insurance issued by a person licensed by a State to engage in the business of insurance.'. SEC. 5. EFFECTIVE DATE. The amendments made by this Act shall apply with respect to changes in group health plan coverage adopted on or after the date of the enactment of this Act.