Section 1 Short title
This Act may be cited as the “Protecting Patients from Deceptive Health Plans Act”.
Protecting Patients from Deceptive Health Plans Act
A BILL
To amend title XXVII of the Public Health Service Act, title I of the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to limit enrollment in coverage for excepted benefits to individuals enrolled in a health plan providing minimum essential coverage.
Sec. 2 Modifying excepted benefits with respect to certain plans
Public Health Service Act—
Additional requirements for excepted benefit— Section 2722(c)(2) of the Public Health Service Act (42 U.S.C. 300gg–21(c)(2)) is amended—
in subparagraph (B), by striking “sponsor.” and inserting “sponsor, or with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer.”; and
by adding at the end the following:
“(D) Such benefits are paid without regard to, and do not vary based on, the severity of the illness, injury, diagnosis, or other characteristics related to treatment for which such benefits are paid.
“(E) With respect to such benefits, the separate policy, certificate, or contract of insurance is provided only to an individual enrolled in minimum essential coverage (as defined in section 5000A(f) of the Internal Revenue Code of 1986), and such minimum essential coverage’s share of the total allowed costs (as determined for purposes of section 36B(c)(2)(C)(ii) of such Code) of benefits provided under such minimum essential coverage is greater than or equal to 60 percent of such costs.”
Modification of certain excepted benefits— Section 2791(c) of the Public Health Service Act (42 U.S.C. 300gg–91(c)) is amended—
in paragraph (1)(A), by striking “accident” and all that follows through “combination thereof”, and inserting “disability income insurance”; and
in paragraph (3), by adding at the end the following:
“(C) Coverage only for accident.”
Employee Retirement Income Security Act—
Additional requirements for excepted benefits— Section 732(c)(2) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191a(c)(2)) is amended by adding at the end the following:
“(D) Such benefits are paid without regard to, and do not vary based on, the severity of the illness, injury, diagnosis, or other characteristics related to treatment for which such benefits are paid.
“(E) With respect to such benefits, the separate policy, certificate, or contract of insurance is provided only to a participant or beneficiary enrolled in minimum essential coverage (as defined in section 5000A(f) of the Internal Revenue Code of 1986), and such minimum essential coverage’s share of the total allowed costs (as determined for purposes of section 36B(c)(2)(C)(ii) of such Code) of benefits provided under such minimum essential coverage is greater than or equal to 60 percent of such costs.”
Modification of certain excepted benefits— Section 733(c) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(c)) is amended—
in paragraph (1)(A), by striking “accident” and all that follows through “combination thereof”, and inserting “disability income insurance”; and
in paragraph (3), by adding at the end the following:
“(C) Coverage only for accident.”
Internal Revenue Code—
Additional requirements for excepted benefits— Section 9831(c)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following:
“(D) Such benefits are paid without regard to, and do not vary based on, the severity of the illness, injury, diagnosis, or other characteristics related to treatment for which such benefits are paid.
“(E) With respect to such benefits, the separate policy, certificate, or contract of insurance is provided only to a participant or beneficiary enrolled in minimum essential coverage (as defined in section 5000A(f)), and such minimum essential coverage’s share of the total allowed costs (as determined for purposes of section 36B(c)(2)(C)(ii)) of benefits provided under such minimum essential coverage is greater than or equal to 60 percent of such costs.”
Modification of certain excepted benefits— Section 9832(c) of the Internal Revenue Code of 1986 is amended—
in paragraph (1)(A), by striking “accident” and all that follows through “combination thereof”, and inserting “disability income insurance”; and
in paragraph (3), by adding at the end the following:
“(C) Coverage only for accident.”
Effective date— The amendments made by this section shall take effect beginning January 1, 2023, and shall apply with respect to policies issued, sold, or renewed on or after such date.