To provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior.

Requires a group health plan, and a health insurance issuer offering group health insurance coverage in the group market or health insurance coverage in the individual market, for plan years beginning on or after January 1, 2010, to provide premium discounts for healthy behavior and improvements toward healthy behavior.

Requires the Secretary of Health and Human Services (HHS), acting through the Director of the Centers for Disease Control and Prevention (CDC), to conclude a rulemaking procedure to determine the appropriate premium discount applicable to each healthy behavior and each improvement toward healthy behavior.

Describes "healthy behavior" (and improvements toward such behavior) as indicated by factors related to smoking, blood pressure, body mass index, lipoprotein levels, and hemoglobin A1c levels.

Requires any healthy behavior or improvement toward healthy behavior to be supported by medical test result information which is certified by a licensed physician, and the individual to whom it relates, as being complete, accurate, and current. Imposes civil penalties for false certifications.

[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3472 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3472

To provide for health insurance coverage premium discounts for healthy 
           behavior and improvements toward healthy behavior.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 31, 2009

 Mrs. Dahlkemper introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Committees 
     on Ways and Means and Education and Labor, 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 provide for health insurance coverage premium discounts for healthy 
           behavior and improvements toward healthy behavior.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. PREMIUM DISCOUNTS FOR HEALTHY LIVING.

    (a) In General.--Notwithstanding any other provision of law, for 
plan years beginning on or after January 1, 2010, a group health plan, 
and a health insurance issuer offering group health insurance coverage 
in the group market or health insurance coverage in the individual 
market, shall provide premium discounts for healthy behavior and 
improvements toward healthy behavior as determined under this section.
    (b) Determination of Premium Discounts.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services, acting through the Director of the Centers for 
        Disease Control and Prevention, shall conclude a rulemaking 
        procedure to determine the appropriate premium discount 
        applicable to each healthy behavior and each improvement toward 
        healthy behavior. Such discounts shall be consistent with the 
        regulations applicable to wellness programs issued under the 
        Health Insurance Portability and Accountability Act of 1996.
            (2) Limitation.--Such discounts shall not, in the 
        aggregate, exceed 20 percent with respect to any individual.
    (c) Healthy Behavior.--For purposes of this section, the following 
are healthy behaviors:
            (1) Not smoking.
            (2) Low blood pressure (but within the normal range).
            (3) Body mass index (BMI) in the normal range.
            (4) Low low-density lipoprotein (LDL) levels.
            (5) High high-density lipoprotein (HDL) levels.
            (6) Appropriate hemoglobin AIC levels.
    (d) Improvements Towards Healthy Behavior.--For purposes of this 
section, the following are improvements towards healthy behavior:
            (1) Quitting smoking.
            (2) Reducing blood pressure, but not below the normal 
        range.
            (3) Lowering body mass index (BMI), but not below the 
        normal range.
            (4) Lowering low-density lipoprotein (LDL) levels.
            (5) Increasing high-density lipoprotein (HDL) levels.
            (6) Lowering hemoglobin AIC levels, but not below the 
        normal range.
    (e) Certification.--In order to be taken into account under this 
section, any healthy behavior or improvement towards healthy behavior 
must be supported by medical test result information which is certified 
by a licensed physician, and the individual to whom it relates, as 
being complete, accurate and current. In the case of any knowingly 
false certification under this subsection, the Secretary of Health and 
Human Services shall impose a civil monetary penalty not in excess of 
$1,000.
    (f) Application to ERISA, PHSA, and IRC.--The provisions of this 
section shall apply with respect to a group health plan as if included 
under title XXVII of the Public Health Service Act, under title VII of 
the Employee Retirement Income Security Act of 1974, and under 
subchapter B of chapter 100 of the Internal Revenue Code of 1986, and 
shall apply with respect to health insurance coverage offered in the 
individual market as if included under title XXVII of the Public Health 
Service Act.
                                 <all>