SEC. 9801. INCREASED PORTABILITY THROUGH LIMITATION ON PREEXISTING CONDITION
EXCLUSIONS.
Title[ Title IV\Subtitle A\401 Contents
``(a) Limitation on Preexisting Condition Exclusion Period;
Crediting for Periods of Previous Coverage.--Subject to subsection (d),
a group health plan may, with respect to a participant or beneficiary,
impose a preexisting condition exclusion only if--
``(1) such exclusion relates to a condition (whether
physical or mental), regardless of the cause of the condition,
for which medical advice, diagnosis, care, or treatment was
recommended or received within the 6-month period ending on the
enrollment date;
``(2) such exclusion extends for a period of not more than
12 months (or 18 months in the case of a late enrollee) after
the enrollment date; and
``(3) the period of any such preexisting condition exclusion
is reduced by the length of the aggregate of the periods of
creditable coverage (if any) applicable to the participant or
beneficiary as of the enrollment date.
``(b) Definitions.--For purposes of this section--
``(1) Preexisting condition exclusion.--
``(A) In general.--The term `preexisting condition
exclusion' means, with respect to coverage, a limitation
or exclusion of benefits relating to a condition based
on the fact that the condition was present before the
date of enrollment for such coverage, whether or not any
medical advice, diagnosis, care, or treatment was
recommended or received before such date.
``(B) Treatment of genetic information.--For
purposes of this section, genetic information shall not
be
treated as a condition described in subsection (a)(1) in
the absence of a diagnosis of the condition related to
such information.
``(2) Enrollment date.--The term `enrollment date' means,
with respect to an individual covered under a group health plan,
the date of enrollment of the individual in the plan or, if
earlier, the first day of the waiting period for such
enrollment.
``(3) Late enrollee.--The term `late enrollee' means, with
respect to coverage under a group health plan, a participant or
beneficiary who enrolls under the plan other than during--
``(A) the first period in which the individual is
eligible to enroll under the plan, or
``(B) a special enrollment period under subsection
(f).
``(4) Waiting period.--The term `waiting period' means, with
respect to a group health plan and an individual who is a
potential participant or beneficiary in the plan, the period
that must pass with respect to the individual before the
individual is eligible to be covered for benefits under the
terms of the plan.
``(c) Rules Relating to Crediting Previous Coverage.--
``(1) Creditable coverage defined.--For purposes of this
part, the term `creditable coverage' means, with respect to an
individual, coverage of the individual under any of the
following:
``(A) A group health plan.
``(B) Health insurance coverage.
``(C) Part A or part B of title XVIII of the Social
Security Act.
``(D) Title XIX of the Social Security Act, other
than coverage consisting solely of benefits under
section 1928.
``(E) Chapter 55 of title 10, United States Code.
``(F) A medical care program of the Indian Health
Service or of a tribal organization.
``(G) A State health benefits risk pool.
``(H) A health plan offered under chapter 89 of
title 5, United States Code.
``(I) A public health plan (as defined in
regulations).
``(J) A health benefit plan under section 5(e) of
the Peace Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of
coverage of excepted benefits (as defined in section 9805(c)).
``(2) Not counting periods before significant breaks in
coverage.--
``(A) In general.--A period of creditable coverage
shall not be counted, with respect to enrollment of an
individual under a group health plan, if, after such
period and before the enrollment date, there was a 63-
day period during all of which the individual was not
covered under any creditable coverage.
``(B) Waiting period not treated as a break in
coverage.--For purposes of subparagraph (A) and
subsection (d)(4), any period that an individual is in a
waiting period for any coverage under a group health
plan or is in an affiliation period shall not be taken
into account in determining the continuous period under
subpara-
graph (A).
``(C) Affiliation period.--
``(i) In general.--For purposes of this
section, the term `affiliation period' means a
period which, under the terms of the health
insurance coverage offered by the health
maintenance organization, must expire before the
health insurance coverage becomes effective.
During such an affiliation period, the
organization is not required to provide health
care services or benefits and no premium shall be
charged to the participant or beneficiary.
``(ii) Beginning.--Such period shall begin on
the enrollment date.
``(iii) Runs concurrently with waiting
periods.--Any such affiliation period shall run
concurrently with any waiting period under the
plan.
``(3) Method of crediting coverage.--
``(A) Standard method.--Except as otherwise provided
under subparagraph (B), for purposes of applying
subsection (a)(3), a group health plan shall count a
period of creditable coverage without regard to the
specific benefits for which coverage is offered during
the period.
``(B) Election of alternative method.--A group
health plan may elect to apply subsection (a)(3) based
on coverage of any benefits within each of several
classes or categories of benefits specified in
regulations rather than as provided under subparagraph
(A). Such election shall be made on a uniform basis for
all participants and beneficiaries. Under such election
a group health plan shall count a period of creditable
coverage with respect to any class or category of
benefits if any level of benefits is covered within such
class or category.
``(C) Plan notice.--In the case of an election with
respect to a group health plan under subparagraph (B),
the plan shall--
``(i) prominently state in any disclosure
statements concerning the plan, and state to each
enrollee at the time of enrollment under the plan,
that the plan has made such election, and
``(ii) include in such statements a
description of the effect of this election.
``(4) Establishment of period.--Periods of creditable
coverage with respect to an individual shall be established
through presentation of certifications described in subsection
(e) or in such other manner as may be specified in regulations.
``(d) Exceptions.--
``(1) Exclusion not applicable to certain newborns.--Subject
to paragraph (4), a group health plan may not impose any
preexisting condition exclusion in the case of an individual
who, as of the last day of the 30-day period beginning with the
date of birth, is covered under creditable coverage.
``(2) Exclusion not applicable to certain adopted
children.--Subject to paragraph (4), a group health plan may not
impose any preexisting condition exclusion in the case of a
child who is adopted or placed for adoption before attaining 18
years of age and who, as of the last day of the 30-day period
beginning on the date of the adoption or placement for adoption,
is covered under creditable coverage. The previous sentence
shall not apply to coverage before the date of such adoption or
placement for adoption.
``(3) Exclusion not applicable to pregnancy.--For purposes
of this section, a group health plan may not impose any
preexisting condition exclusion relating to pregnancy as a
preexisting condition.
``(4) Loss if break in coverage.--Paragraphs (1) and (2)
shall no longer apply to an individual after the end of the
first 63-day period during all of which the individual was not
covered under any creditable coverage.
``(e) Certifications and Disclosure of Coverage.--
``(1) Requirement for certification of period of
creditable coverage.--
``(A) In general.--A group health plan shall provide
the certification described in subparagraph (B)--
``(i) at the time an individual ceases to be
covered under the plan or otherwise becomes
covered under a COBRA continuation provision,
``(ii) in the case of an individual becoming
covered under such a provision, at the time the
individual ceases to be covered under such
provision, and
``(iii) on the request on behalf of an
individual made not later than 24 months after the
date of cessation of the coverage described in
clause (i) or (ii), whichever is later.
The certification under clause (i) may be provided, to
the extent practicable, at a time consistent with
notices required under any applicable COBRA continuation provision.
``(B) Certification.--The certification described in
this subparagraph is a written certification of--
``(i) the period of creditable coverage of the
individual under such plan and the coverage under
such COBRA continuation provision, and
``(ii) the waiting period (if any) (and
affiliation period, if applicable) imposed with
respect to the individual for any coverage under
such plan.
``(C) Issuer compliance.--To the extent that medical
care under a group health plan consists of health
insurance coverage offered in connection with the plan,
the plan is deemed to have satisfied the certification
requirement under this paragraph if the issuer provides
for such certification in accordance with this
paragraph.
``(2) Disclosure of information on previous benefits.--
``(A) In general.--In the case of an election
described in subsection (c)(3)(B) by a group health
plan, if the plan enrolls an individual for coverage
under the plan and the individual provides a
certification of coverage of the individual under
paragraph (1)--
``(i) upon request of such plan, the entity
which issued the certification provided by the
individual shall promptly disclose to such
requesting plan information on coverage of classes
and categories of health benefits available under
such entity's plan, and
``(ii) such entity may charge the requesting
plan or issuer for the reasonable cost of
disclosing such information.
``(3) Regulations.--The Secretary shall establish rules to
prevent an entity's failure to provide information under
paragraph (1) or (2) with respect to previous coverage of an
individual from adversely affecting any subsequent coverage of
the individual under another group health plan or health
insurance coverage.
``(f) Special Enrollment Periods.--
``(1) Individuals losing other coverage.--A group health
plan shall permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a dependent of such
an employee if the dependent is eligible, but not enrolled, for
coverage under such terms) to enroll for coverage under the
terms of the plan if each of the following conditions is met:
``(A) The employee or dependent was covered under a
group health plan or had health insurance coverage at
the time coverage was previously offered to the employee
or individual.
``(B) The employee stated in writing at such time
that coverage under a group health plan or health
insurance coverage was the reason for declining
enrollment, but only if the plan sponsor (or the health
insurance issuer offering health insurance coverage in
connection with the plan) required such a statement at
such time and provided the employee with notice of such
requirement (and the consequences of such requirement)
at such time.
``(C) The employee's or dependent's coverage
described in subparagraph (A)--
``(i) was under a COBRA continuation provi-
sion and the coverage under such provision was
exhausted; or
``(ii) was not under such a provision and
either the coverage was terminated as a result of
loss of eligibility for the coverage (including as
a result of legal separation, divorce, death,
termination of employment, or reduction in the
number of hours of employment) or employer
contributions toward such coverage were
terminated.
``(D) Under the terms of the plan, the employee
requests such enrollment not later than 30 days after
the date of exhaustion of coverage described in
subparagraph (C)(i) or termination of coverage or
employer contribution described in subparagraph (C)(ii).
``(2) For dependent beneficiaries.--
``(A) In general.--If--
``(i) a group health plan makes coverage
available with respect to a dependent of an
individual,
``(ii) the individual is a participant under
the plan (or has met any waiting period applicable
to becoming a participant under the plan and is
eligible to be enrolled under the plan but for a
failure to enroll during a previous enrollment
period), and
``(iii) a person becomes such a dependent of
the individual through marriage, birth, or
adoption or placement for adoption,
the group health plan shall provide for a dependent
special enrollment period described in subparagraph (B)
during which the person (or, if not otherwise enrolled,
the individual) may be enrolled under the plan as a
dependent of the individual, and in the case of the
birth or adoption of a child, the spouse of the
individual may be enrolled as a dependent of the
individual if such spouse is otherwise eligible for
coverage.
``(B) Dependent special enrollment period.--The
dependent special enrollment period under this
subparagraph shall be a period of not less than 30 days
and shall begin on the later of--
``(i) the date dependent coverage is made
avail-
able, or
``(ii) the date of the marriage, birth, or
adoption or placement for adoption (as the case
may be) described in subparagraph (A)(iii).
``(C) No waiting period.--If an individual seeks
coverage of a dependent during the first 30 days of such
a dependent special enrollment period, the coverage of
the dependent shall become effective--
``(i) in the case of marriage, not later than
the first day of the first month beginning after
the date the completed request for enrollment is
received;
``(ii) in the case of a dependent's birth, as
of the date of such birth; or
``(iii) in the case of a dependent's adoption
or placement for adoption, the date of such
adoption or placement for adoption.
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