[Congressional Record (Bound Edition), Volume 154 (2008), Part 15] [House] [Pages 20280-20282] [From the U.S. Government Publishing Office, www.gpo.gov]HEALTH INSURANCE RESTRICTIONS AND LIMITATIONS CLARIFICATION ACT OF 2008 Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 6908) to require that limitations and restrictions on coverage under group health plans be timely disclosed to group health plan sponsors and timely communicated to participants and beneficiaries under such plans in a form that is easily understandable, as amended. The Clerk read the title of the bill. The text of the bill is as follows: H.R. 6908 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 ``Health Insurance Restrictions and Limitations Clarification Act of 2008''. SEC. 2. DISCLOSURE REQUIREMENTS. (a) ERISA.--Section 702(a)(2)(B) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1182(a)(2)(B)) is amended by inserting before the period at the end the following: ``so long as-- ``(i) such limitations and restrictions are explicit and clear; ``(ii) in the case of such limitations and restrictions in health insurance coverage offered in connection with the group health plan, such limitations and restrictions have been disclosed in writing to the plan sponsor in advance of the point of sale to the plan; ``(iii) the plan sponsor of the health insurance coverage provide, to participants and beneficiaries in the plan in advance of the point of their enrollment under the plan, a description of such limitations and restrictions in a form that is easily understandable by such participants and beneficiaries; and ``(iv) the plan sponsor and the issuer of the coverage provide such description to participants and beneficiaries upon their enrollment under the plan at the earliest opportunity that other materials are provided''. (b) PHSA.--Section 2702(a)(2)(B) of the Public Health Service Act (42 U.S.C. 300gg-1(a)(2)(B)) is amended by inserting before the period at the end the following: ``so long as-- ``(i) such limitations and restrictions are explicit and clear; ``(ii) in the case of such limitations and restrictions in health insurance coverage offered in connection with the group health plan, such limitations and restrictions have been disclosed in writing to the plan sponsor in advance of the point of sale to the plan; ``(iii) the plan sponsor and the issuer of the group health insurance coverage make available, to participants and beneficiaries in the plan in advance of the point of their enrollment under the plan, a description of such [[Page 20281]] limitations and restrictions in a form that is easily understandable by such participants and beneficiaries; and ``(iv) the plan sponsor and the issuer of the coverage provides such description to participants and beneficiaries upon their enrollment under the plan at the earliest opportunity that other materials are provided''. (c) Internal Revenue Code.--Section 9802(a)(2)(B) of the Internal Revenue Code of 1986 is amended by inserting before the period at the end the following: ``so long as-- ``(i) such limitations and restrictions are explicit and clear; ``(ii) the group health plan makes available, to participants and beneficiaries in the plan in advance of the point of their enrollment under the plan, a description of such limitations and restrictions in a form that is easily understandable by such participants and beneficiaries; and ``(iii) the plan provides such description to participants and beneficiaries upon their enrollment under the plan at the earliest opportunity that other materials are provided''. (d) Effective Date.--The amendments made by this Act shall apply with respect to plan years beginning after 1 year after the date of the enactment of this Act. The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each will control 20 minutes. The Chair recognizes the gentleman from New Jersey. General Leave Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days to revise and extend their remarks and include extraneous material on the bill under consideration. The SPEAKER pro tempore. Is there objection to the request of the gentleman from New Jersey? There was no objection. Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in strong support of H.R. 6908, the Health Insurance Source of Injury Clarification Act of 2008. This bill would prohibit health insurers from restricting or denying benefits to plan participants if they are injured while engaging in legal recreational activities like riding a motorcycle, skiing, snowmobiling or horseback riding unless such restrictions were made explicitly clear by the plan to the person before he or she enrolled. Mr. Speaker, this change is necessary because of a 2001 rule that was issued in accordance with the Health Insurance Portability and Accountability Act of 1996. {time} 1945 While that 1996 rule prohibits employer health plans and insurers from denying coverage to individuals who engage in legal recreational activities, the rule ironically allows the denial of health care benefits for injuries sustained while participating in such recreational activities. If I could explain that again, you can't deny coverage, but you can deny benefits, which obviously makes no sense. Accordingly, the rule in its current form will allow insurance companies to treat health care benefits coverage arbitrarily and capriciously. Under the current rule, a plan could for example deny coverage for someone who has broken an arm through skiing or riding a motorcycle but would cover someone who sustained a similar injury from drinking and driving. What is worse is that a person might not even know that their health care coverage was even subject to such limitations until after they were actually injured. So, Mr. Speaker, this is an important consumer protection for millions of Americans who participate in recreational activities every day by providing greater transparency for plan participants. When we enacted the rule in 1996, we did not intend that people would be allowed to purchase health insurance only to find out after the fact that they had no coverage for an injury resulting from a common recreational activity. This bill simply clarifies that point. I want to thank Mr. Stupak and Dr. Burgess who have worked very hard on this legislation. I urge my colleagues on both sides of the aisle to support its adoption. I reserve the balance of my time. Mr. BURGESS. Mr. Speaker, I thank the chairman of the subcommittee for bringing the bill to the floor tonight. This is an important bill, an important bill to me and an important bill to Mr. Stupak of Michigan. We've worked on this for a number of years through a number of sessions of Congress. In January 2001, the Department of Labor, the Internal Revenue Service and the Health Care Financing Administration, as it was then known, issued a rule in accordance to the Health Insurance Portability and Accountability Act of 1996 that was designed to guard against discrimination in coverage in the group health market. While addressing the issue of discrimination based upon participation in certain activities, these rules allowed continued health plan nonpayment based upon the source of an injury. This resulted in a situation where some people who have paid the premiums and believed they would be covered by their plans were actually responsible for paying for their own medical treatment because the exclusions were either unclear or very, very broad. The lack of clarity underlying these exclusions has created a confusing situation for individuals that may ride a motorcycle, might ride on horseback, might operate a snowmobile or participate in other activities that could result in an injury. Millions of Americans enjoy these activities safely every year within the framework of State laws and utilizing proper safety precautions. Earlier last year Congressman Stupak and I introduced H.R. 1076 to restore fairness and equity to the situation. In response to concerns raised during discussions on this bill, the House Energy and Commerce staff, my staff and Mr. Stupak's staff have all worked together in a bipartisan manner to address certain areas of concern. As a result of these conversations in negotiations, we have reintroduced our original legislation to encapsulate the agreed-to principles. H.R. 6908, the Health Insurance Source of Injury Clarification Act will, number one, require any limitations and restrictions on health plan benefits be spelled out, that they be explicit, that they be clear; number two, require that they be disclosed to the sponsor of the group health plan in advance of the point of sale of the group health plan; and, thirdly, require that the issuer of the health insurance coverage make available to participants and beneficiaries in an easily understandable manner a description of the limitations and restrictions upon their enrollment. This legislation is supported by a number of groups. The American Motorcyclist Association has been very supportive and very vocal in their support of this legislation, and I certainly appreciate their efforts in advocating for an issue that is very important to them, likewise the Motorcycle Riders Foundation. In addition, the American Council of Snowmobile Association, the American Horse Council, the American Recreational Coalition, American Trails, Americans for Responsible Recreational Access, the Blue Ribbon Coalition, the International Mountain Bicycling Association, the National Ski Areas Association, the Specialty Vehicle Industry Council, the Sporting Goods Manufacturing Association, the Washington Road Riders Association, and many others support this legislation. Mr. Speaker, again, this is a culmination of many, many months and indeed years of work on the Energy and Commerce Committee. Again I want to congratulate the cosponsor of the bill, Mr. Stupak of Michigan, and thank the chairman and the ranking member of the subcommittee for allowing this bill to come forward this evening. Mr. DINGELL. Mr. Speaker, I am pleased to support H.R. 6908, a bill introduced by Representatives Bart Stupak and Michael Burgess. H.R. 6908 represents a compromise that achieves everyone's goals and is acceptable to all. As a result, the Committee on Energy and Commerce favorably reported the bill last week. H.R. 6908 requires transparency in healthcare benefits. An insurer is required to explicitly and clearly state any restrictions and limitations on benefits. You would not buy a car without knowing if it was new or used. Why should you buy health insurance without knowing whether the benefits you may need are included? [[Page 20282]] This bill does not change what benefits an insurer provides. It merely requires that restrictions be transparent to the consumer. Specifically, this bill requires: (1) that any limitations on benefits be explicit and clear; (2) that they be disclosed to plan sponsors in advance of the point of sale; and (3) that they be disclosed to participants and beneficiaries in a manner that is easily understandable in advance of enrollment and after enrollment. This is a commonsense bill, and it is surprising we have not required such transparency before. I urge my fellow colleagues to support passage of H.R. 6908. Mr. STUPAK. Mr. Speaker, this legislation does one simple thing--it requires health insurance companies to be up front and honest with their policyholders when they place limitations and restrictions on benefits prior to selling them an insurance policy. Currently, the way insurance regulations are set, many Americans are unaware that their health insurance may not cover injuries resulting from certain recreational activities because their policy is unclear or very broad. This lack of clarity has created a confusing situation for individuals that may ride motorcycles, horses, snowmobiles, or participate in other recreational activities. While millions of Americans enjoy these activities safely every year, when an individual is injured, they often find that their insurance will not cover their medical expenses until it is too late. H.R. 6908 would require that any limitations and restrictions on insurance benefits be explicit and clear. Insurance companies would be required to make available to participants and beneficiaries in an easily understandable manner a description of the limitations and restrictions included in the policy. By passing this straightforward legislation, we will protect our constituents that ride motorcycles, horses, snowmobiles, or participate in other recreational activities from being caught by surprise when they thought that their policy covered any possible injuries from their accident. I encourage all of my colleagues to vote in support of this legislation. I want to thank Congressman Burgess for his work on this legislation as well as Chairmen Dingell and Barton. I also want to thank Bridgett Taylor, Ryan Long, and Josh Martin with the Committee staff and Erika Orloff of my personal staff for their hard work on this legislation. Mr. BURGESS. Seeing no other speakers on my side, I yield back the balance of my time. Mr. PALLONE. Mr. Speaker, I have no further requests for time, and I would urge passage of this bill. I yield back the balance of my time. The SPEAKER pro tempore. The question is on the motion offered by the gentleman from New Jersey (Mr. Pallone) that the House suspend the rules and pass the bill, H.R. 6908, as amended. The question was taken; and (two-thirds being in the affirmative) the rules were suspended and the bill, as amended, was passed. A motion to reconsider was laid on the table. ____________________