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Children Health Insurance Access Amendments of 1996
To amend the Public Health Service Act to assure the availability of health insurance coverage for children in the individual market in a manner similar to guaranteed availability of individual health insurance coverage for certain previously covered individuals under the Health Insurance Portability and Accountability Act of 1996.
Summary
This bill amends the Public Health Service Act to guarantee availability of individual health insurance coverage for uninsured children in a manner similar to protections provided to adults under the Health Insurance Portability and Accountability Act of 1996. Health insurance issuers offering individual market coverage cannot deny enrollment to eligible children and must limit preexisting condition exclusions to only those permitted for non-late enrollees. Premium ratios between eligible children and eligible adults cannot exceed the ratio of the actuarial value of coverage for children to the actuarial value for adults. Eligible children are defined as individuals born after September 30, 1983, under age 16, who are citizens or permanent residents, not eligible for group health plans or government programs, and whose recent coverage was not terminated for nonpayment or fraud. States may implement alternative acceptable mechanisms instead of the individual market guarantee requirement, with extended deadlines to comply.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
Actions (4)
- Oct 11, 1996 Referred to the Subcommittee on Health and Environment. · house
- Oct 11, 1996 Referred to the Subcommittee on Commerce, Trade, and Hazardous Materials. · house
- Sep 28, 1996 Referred to the House Committee on Commerce. · house
- Sep 28, 1996 Introduced in House
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Full text
IN THE HOUSE OF REPRESENTATIVES
September 28, 1996
Ms. Furse introduced the following bill; which was referred to the Committee on Commerce
A BILL
To amend the Public Health Service Act to assure the availability of health insurance coverage for children in the individual market in a manner similar to guaranteed availability of individual health insurance coverage for certain previously covered individuals under the Health Insurance Portability and Accountability Act of 1996.
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 “Children Health Insurance Access Amendments of 1996”.
SEC. 2. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
(a) In General.—Title XXVII of the Public Health Service Act, as added by section 111(a) of the Health Insurance Portability and Accountability Act of 1996, is amended by inserting after section 2741 the following new section:
“SEC. 2741A. GUARANTEED AVAILABILITY OF INDIVIDUAL HEALTH INSURANCE COVERAGE TO UNINSURED CHILDREN.
“(a) Guaranteed Availability.—
“(1) In general.—Subject to the succeeding subsections of this section, each health insurance issuer that offers health insurance coverage (as defined in section 2791(b)(1)) in the individual market in a State, in the case of an eligible child (as defined in subsection (b)) desiring to enroll in individual health insurance coverage—
“(A) may not decline to offer such coverage to, or deny enrollment of, such child;
“(B) either (i) does not impose any preexisting condition exclusion (as defined in section 2701(b)(1)(A)) with respect to such coverage, or (ii) imposes such a preexisting condition exclusion only to the extent such an exclusion may be imposed under section 2701(a) in the case of an individual who is not a late enrollee; and
“(C) shall provide that the premium for the coverage is determined in a manner so that the ratio of the premium for such eligible children to the premium for eligible individuals described in section 2741(b) does not exceed the ratio of the actuarial value of such coverage (calculated based on a standardized population and a set of standardized utilization and cost factors) for children to such actuarial value for such coverage for such eligible individuals.
“(2) Substitution by state of acceptable alternative mechanism.—The requirement of paragraph (1) shall not apply to health insurance coverage offered in the individual market in a State in which the State is implementing an acceptable alternative mechanism under section 2744.
“(b) Eligible Child Defined.—In this part, the term ‘eligible child’ means an individual born after September 30, 1983, who has not attained 16 years of age and—
“(1) who is a citizen or national of the United States, an alien lawfully admitted for permanent residence, or an alien otherwise permanently residing in the United States under color of law;
“(2) who is not eligible for coverage under (A) a group health plan, (B) part A or part B of title XVIII of the Social Security Act, or (C) a State plan under title XIX of such Act (or any successor program), and does not have other health insurance coverage; and
“(3) with respect to whom the most recent coverage (if any, within the 1-year period ending on the date coverage is sought under this section) was not terminated based on a factor described in paragraph (1) or (2) of section 2712(b) (relating to nonpayment of premiums or fraud). For purposes of paragraph (2)(A), the term ‘group health plan’ does not include COBRA continuation coverage.
“(c) Incorporation of Certain Provisions.—
“(1) In general.—Subject to paragraph (2), the provisions of subsections (c), (d), (e) and (f) (other than paragraph (1)) of section 2741 and section 2744 shall apply in relation to eligible children under subsection (a) in the same manner as they apply in relation to eligible individuals under section 2741(a).
“(2) Special rules for acceptable alternative mechanisms.—With respect to applying section 2744 under paragraph (1)—
“(A) the requirement in subsection (a)(1)(B) shall be applied instead of the requirement of section 2744(a)(1)(B);
“(B) the requirement in subsection (a)(1)(C) shall be applied instead of the requirement of section 2744(a)(1)(D); and
“(C) any deadline specified in such section shall be 6 months after the deadline otherwise specified.”.
(b) Effective Date.—The amendment made by subsection (a) shall take effect as if included in the enactment of section 2741 of the Public Health Service Act under section 111(a) of the Health Insurance Portability and Accountability Act of 1996. <all>
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