Here is the entire language in the recent House Bill:
SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS.
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent basedon any health status-related factors (as defined in section2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
That's it. Analysis below:
Again, here is the Bill's language
SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS.
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
Here is the Bill language WITH the Public Health Service Act Sections 2701 and 2791 refered to copied and pasted. Thanks to nsfbr for providing the link to the Public Health Service Act , as Amended through 2004, 108th Congress, Republican majority in both House and Senate:
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act)
Here is Title XXVII, Sec. 2701 of the Public Health Service Act, in which Congress gave permission to the insurance companies to implement the pre-existing clauses in their policies. Which Congress initiated this law? Anyone.....
TITLE XXVII—REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
PART A—GROUP MARKET REFORMS
Subpart 1—Portability, Access, and Renewability Requirements
SEC. 2701. INCREASED PORTABILITY THROUGH LIMITATION ON PREEXISTING CONDITION EXCLUSIONS.
(a) LIMITATION ON PRE-EXISTING CONDITION EXCLUSION PERIOD;
CREDITING FOR PERIODS OF PREVIOUS COVERAGE.—Subject to sub-
section (d), a group health plan, and a health insurance issuer of-
fering group health insurance coverage, may, with respect to a par-
ticipant 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 enroll-
ment 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 aggregate of the periods of creditable cov-
erage (if any, as defined in subsection (c)(1)) applicable to the
participant or beneficiary as of the enrollment date.
(b) DEFINITIONS.—For purposes of this part—
(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.
Back to the Pre-Existing Clause in the House Bill under consideration:
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
Section 2791(d)(9)
HEALTH STATUS-RELATED FACTOR.—The term ‘‘health
status-related factor’’ means any of the factors described in sec-
tion 2702(a)(1).
Section 2702(a)(1)
PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.
(a) INELIGIBILITY TO ENROLL.—
(1) IN GENERAL.—Subject to paragraph (2), a group health
plan, and a health insurance issuer offering group health
insurance coverage in connection with a group health plan,
may not establish rules for eligibility (including continued eli-
gibility) of any individual to enroll under the terms of the plan
based on any of the following health status-related factors in
relation to the individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both physical and
mental illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including conditions aris-
ing out of acts of domestic violence).
(H) Disability.
- NO APPLICATION TO BENEFITS OR EXCLUSIONS.—To the
extent consistent with section 701, paragraph (1) shall not be
construed—
(A) to require a group health plan, or group health
insurance coverage, to provide particular benefits other
than those provided under the terms of such plan or cov-
erage, or
(B) to prevent such a plan or coverage from estab-
lishing limitations or restrictions on the amount, level, ex-
tent, or nature of the benefits or coverage for similarly sit-
uated individuals enrolled in the plan or coverage.
(3) CONSTRUCTION.—For purposes of paragraph (1), rules
for eligibility to enroll under a plan include rules defining any
applicable waiting periods for such enrollment.
The above quotes found at:
http://energycommerce.house.gov/...
I am interesting in your analysis. These are the questions I have:
- When will the end of pre-existing conditions as an excuse to not pay for medical care end? Immediately, in 2013, or for the grandfathered policies, 2018?
- Will it be applied to ALL existing health insurance policies and future policies. Is there any possibility that a policy can be offered WITH a pre-existing condition clause as a cheap health insurance policy?
- Will this Federal Bill trump any/all contrary laws in place within all the States? In other words, will an insurer residing strictly within a state be ruled by the Federal or State law? Will States have to adopt new laws to reflect the new federal law?
- Is there any way a loophole will be found by the insurers?
At least Congress kept it short, but it could be much more simply written, do you think?
E N D OF PRE-EXISTING CONDITION DISCUSSION