Core Provisions: This legislation would amend the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code to prohibit pre-existing condition exclusions in all group and individual health coverage policies.  The bill would also prohibit HMOs from requiring “affiliation periods,” which must expire before health insurance coverage becomes effective.  The legislation would also amend the Public Health Service Act to require all insurers in the group and individual markets to accept applications for coverage from every otherwise eligible employer and individual within the coverage area - a restriction that formerly only applied to insurers in the small group market.  An insurer would be left with the ability to deny coverage if it lacked the financial reserves necessary to underwrite additional coverage so long as its denial was applied uniformly without regard to the claims experiences of the employers and their employees, or any health status-related factor relating to the employees and their dependents.  The insurer would then be prohibited from offering coverage in that market for at least 180 days, until the insurer has sufficient financial reserves to underwrite additional coverage. 

Under this legislation, each insurer would also be required to “charge the same premium price for the same coverage,” and disclose the amount of the premium price that is being charged for the coverage involved.  This disclosure would be affected in a manner specified by the Secretary of Labor, including disclosure via the Internet.  The uniform premium requirement would apply within geographic areas and “family categories,” but would not prohibit variations in premiums resulting from the application of a uniform monthly premium over different policy years.  The legislation’s requirements would not apply to health plans pursuant to collective bargaining agreements for plan years beginning before the later of (a) the termination date of the last collective bargaining agreement or (b) January 1, 2010.  The Secretary of Labor would also be authorized to establish rules to deter individuals from enrolling in individual health insurance coverage only after they develop an illness or injury, and from disenrolling from coverage for periods in which they are less likely to require coverage.  

Status: On February 14, 2008, H.R.5449 was introduced by Rep. Kagen (D-WI) and referred to the House Committees on Education and Labor, Energy and Commerce, and Ways and Means.