[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 848 Introduced in House (IH)]
108th CONGRESS
1st Session
H. R. 848
To amend the Employee Retirement Income Security Act of 1974, the
Public Health Service Act, and the Internal Revenue Code of 1986 to
require that group and individual health insurance coverage and group
health plans provide for prompt payment for health benefits claims.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2003
Mr. Sandlin introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and the Workforce and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974, the
Public Health Service Act, and the Internal Revenue Code of 1986 to
require that group and individual health insurance coverage and group
health plans provide for prompt payment for health benefits claims.
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 ``Health Benefits Claims Prompt
Payment Act of 2003''.
SEC. 2. PROMPT PAYMENT OF CLAIMS.
(a) Group Health Plans.--
(1) Public health service act amendments.--Subpart 2 of
part A of title XXVII of the Public Health Service Act is
amended by adding at the end the following new section:
``SEC. 2707. PROMPT PAYMENT OF CLAIMS.
``(a) In General.--A group health plan, and a health insurance
issuer offering health insurance coverage in connection with a group
health plan, shall provide for prompt payment of claims submitted for
health care services or supplies furnished to a participant,
beneficiary, or enrollee with respect to benefits covered by the plan
or issuer, in a manner that is no less protective than the provisions
referred to in subsection (b).
``(b) Provisions.--The provisions referred to in this subsection
are the provisions of section 1842(c)(2) of the Social Security Act (42
U.S.C. 1395u(c)(2)), as modified as follows:
``(1) Alternative interest rate.--Instead of applying the
interest rate calculated under section 3902(a) of title 31,
United States Code, the interest rate shall be 1 percent of the
payment amount due plus, in the case of payments not made
within 25 days of the due date, an additional 1 percent
interest due for every month the payment is past due.
``(2) Coverage of 100 percent of claims.--The reference in
such section 1842(c)(2) to `not less than 95 percent of all
claims submitted under this part' shall be deemed to be a
reference to `100 percent of all claims submitted under the
plan or coverage involved'.
``(c) Permitting Additional Penalties.--State Insurance
Commissioners may establish and impose monetary penalties or other
penalties for failure by a group health plan, and a health insurance
issuer offering health insurance coverage in connection with a group
health plan, to comply with the provisions referred to in subsection
(b).''.
(2) ERISA amendments.--(A) Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security Act of
1974 is amended by adding at the end the following new section:
``SEC. 714. PROMPT PAYMENT OF CLAIMS.
``(a) In General.--A group health plan, and a health insurance
issuer offering health insurance coverage in connection with a group
health plan, shall provide for prompt payment of claims submitted for
health care services or supplies furnished to a participant or
beneficiary with respect to benefits covered by the plan or issuer, in
a manner that is no less protective than the provisions referred to in
subsection (b).
``(b) Provisions.--The provisions referred to in this subsection
are the provisions of section 1842(c)(2) of the Social Security Act (42
U.S.C. 1395u(c)(2)), as modified as follows:
``(1) Alternative interest rate.--Instead of applying the
interest rate calculated under section 3902(a) of title 31,
United States Code, the interest rate shall be 1 percent of the
payment amount due plus, in the case of payments not made
within 25 days of the due date, an additional 1 percent
interest due for every month the payment is past due.
``(2) Coverage of 100 percent of claims.--The reference in
such section 1842(c)(2) to `not less than 95 percent of all
claims submitted under this part' shall be deemed to be a
reference to `100 percent of all claims submitted under the
plan or coverage involved'.
``(c) Permitting Additional Penalties.--State Insurance
Commissioners may establish and impose monetary penalties or other
penalties for failure by a group health plan, and a health insurance
issuer offering health insurance coverage in connection with a group
health plan, to comply with the provisions referred to in subsection
(b).''.
(B) The table of contents in section 1 of such Act is
amended by inserting after the item relating to section 713 the
following new item:
``Sec. 714. Prompt payment of claims.''.
(3) Internal revenue code amendments.--Subchapter B of
chapter 100 of the Internal Revenue Code of 1986 is amended--
(i) in the table of sections, by inserting
after the item relating to section 9812 the
following new item:
``Sec. 9813. Prompt payment of claims.'';
and
(ii) by inserting after section 9812 the
following:
``SEC. 9813. PROMPT PAYMENT OF CLAIMS.
``A group health plan shall provide for prompt payment of claims
submitted for health care services or supplies furnished to a
participant or beneficiary with respect to benefits covered by the
plan, in a manner that is no less protective than the provisions
referred to in subsection (b).
``(b) Provisions.--The provisions referred to in this subsection
are the provisions of section 1842(c)(2) of the Social Security Act (42
U.S.C. 1395u(c)(2)), as modified as follows:
``(1) Alternative interest rate.--Instead of applying the
interest rate calculated under section 3902(a) of title 31,
United States Code, the interest rate shall be 1 percent of the
payment amount due plus, in the case of payments not made
within 25 days of the due date, an additional 1 percent
interest due for every month the payment is past due.
``(2) Coverage of 100 percent of claims.--The reference in
such section 1842(c)(2) to `not less than 95 percent of all
claims submitted under this part' shall be deemed to be a
reference to `100 percent of all claims submitted under the
plan involved'.
``(c) Permitting Additional Penalties.--State Insurance
Commissioners may establish and impose monetary penalties or other
penalties for failure by a group health plan to comply with the
provisions referred to in subsection (b).''.
(b) Individual Health Insurance.--Part B of title XXVII of the
Public Health Service Act is amended by inserting after section 2752
the following new section:
``SEC. 2753. PROMPT PAYMENT OF CLAIMS.
``The provisions of section 2707 shall apply to health insurance
coverage offered by a health insurance issuer in the individual market
in the same manner as they apply to health insurance coverage offered
by a health insurance issuer in connection with a group health plan in
the small or large group market.''.
(c) Protection of States' Rights.--Any issue relating to prompt
payment for health care services or supplies that is not governed by
any provision of law as amended by this section shall be governed by
otherwise applicable State or Federal law. This section (and the
provisions amended by this section) does not preempt or supersede any
law that imposes shorter time frames for payment, greater penalties for
non-payment, and, in general, provides greater assurances that group
health plans and health insurance issuers provide for prompt payment of
claims submitted for health care services or supplies furnished to a
participant, beneficiary, or enrollee with respect to benefits covered
by the plan or issuer.
(d) Effective Dates.--
(1) Group health plans and group health insurance
coverage.--The amendments made by subsection (a) apply with
respect to group health plans for plan years beginning on or
after January 1, 2004.
(2) Individual health insurance coverage.--The amendment
made by subsection (b) apply with respect to health insurance
coverage offered, sold, issued, renewed, in effect, or operated
in the individual market on or after such date.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Employer-Employee Relations.
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