,i #aacth ,,congress #ast ,session ,h4 ,r4 #cjbj ,,in ,,the ,,house ,,of ,,representatives ,august #b1 #bjac ,mr4 ,dent 7for himself and ,mr4 ,andrews7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on ,education and the ,workforce and ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 #aigd1 the ,public ,health ,service ,act1 and the ,internal ,revenue ,code of #aihf to provide parity under group and individual health plans and group and individual health insurance coverage for the provision of benefits for prosthetics and custom orthotics and benefits for other medical and surgical services4 #a4 ,short title ,this ,act may be cited as the ,insurance ,fairness for ,amputees ,act4 #b4 ,findings and purpose 7a7 ,findings ,congress makes the following findings3 7#a7 ,there are more than #a1gjj1jjj people in the ,united ,states living with limb loss1 many of whom are appropriate candidates for prosthetic care4 ,a comparable number experience trauma1 illness1 or disability that results in musculoskeletal or neuromuscular impairment of the limbs1 back1 and neck requiring the use of orthotic care4 7#b7 ,every year1 there are more than #acj1jjj people in the ,united ,states who undergo amputation procedures4 7#c7 ,in addition1 ,united ,states military personnel serving in ,iraq and ,afghanistan and around the world have sustained traumatic injuries resulting in amputation and musculoskeletal or neuromuscular injury4 7#d7 ,the number of amputations in the ,united ,states is projected to increase in the years ahead due to the rising incidence of diabetes and other chronic illness4 7#e7 ,those experiencing limb loss and limb dysfunction can and want to regain their lives as productive members of society1 and prosthetic and orthotic care often enables amputees and others with orthopedic impairments to continue working and living productive lives4 7#f7 ,insurance companies often restrict coverage for prosthetic and orthotic devices and related services over an individual's lifetime1 which shifts costs onto individuals and consequently to the ,medicare and ,medicaid programs4 7#g7 ,twenty ,states have addressed this problem and have prosthetic or orthotic parity legislation1 which also is being considered actively in other ,states4 7#h7 ,the ,states in which prosthetic or orthotic fairness in coverage laws have been enacted have found there to be minimal or no increases in insurance premiums and have reduced ,medicare and ,medicaid costs4 7#i7 ,coverage of orthotic and prosthetic devices and related services is only appropriate for individuals missing a limb or having an orthopedic condition in need of treatment4 ,therefore1 a fixed population of individuals are candidates for these devices and related services4 7#aj7 ,appropriate and timely treatment involving prosthetic and orthotic devices and related services allow people to regain health function1 preexisting work1 and independent living4 7#aa7 ,prosthetic and orthotic devices and related services are a distinct and separate benefit from the durable medical equipment benefit1 but this distinction often is not recognized as insurers typically combine these benefits under a combined limit4 7#ab7 ,the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and the ,health ,care and ,education ,reconciliation ,act 7,public ,law #aaa-aeb71 include rehabilitative and habilitative services as an essential health benefit1 which legislative history shows is intended to cover prosthetic and orthotic devices and related services4 7#ac7 ,the ,institute of ,medicine concluded that prosthetic and orthotic devices and related services are covered under a typical employer plan4 7#ad7 ,however1 while lifetime and annual dollar limitations on essential health benefits are prohibited under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and the ,health ,care and ,education ,reconciliation ,act 7,public ,law #aaa-aeb71 other techniques to minimize or eliminate coverage continue to be used across the country and are denying individuals access to medically necessary prosthetic and orthotic devices and related services4 7b7 ,purpose ,it is the purpose of this ,act to require that each group and individual health plan and individual and group health insurance coverage that provides medical and surgical benefits and also provides coverage for prosthetics or custom orthotics 7or both71 provide such coverage under terms and conditions that are no less favorable than the terms and conditions under which medical and surgical benefits are provided under such plan4 #c4 ,prosthetics and custom orthotics fairness in coverage 7a7 ,,erisa 7#a7 ,in general ,subpart ,b of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aahe et seq47 is amended by adding at the end the following3 #gaf4 ,prosthetics and custom orthotics fairness in coverage 7a7 ,in general ,in the case of a group health plan 7or health insurance coverage offered in connection with a group health plan7 that provides medical and surgical benefits and also provides benefits for prosthetics or custom orthotics 7as defined under paragraphs 7#a7 and 7#b7 of subsection 7e77 7or both7-- 7#a7 such benefits for prosthetics or custom orthotics 7or both7 under the plan 7or coverage7 shall be provided under terms and conditions that are no less favorable than the terms and conditions applicable to substantially all medical and surgical benefits provided under the plan 7or coverage72 7#b7 such benefits for prosthetics or custom orthotics 7or both7 under the plan 7or coverage7 may not be subject to separate financial requirements 7as defined in subsection 7d77#c77 that are applicable only with respect to such benefits1 and any financial requirements applicable to such benefits shall be no more restrictive than the financial requirements applicable to substantially all medical and surgical benefits provided under the plan 7or coverage72 and 7#c7 any treatment limitations 7as defined in subsection 7d77#d77 applicable to such benefits for prosthetics or custom orthotics 7or both7 under the plan 7or coverage7 may not be more restrictive than the treatment limitations applicable to substantially all medical and surgical benefits provided under the plan 7or coverage74 7b7 ,patient access ,a group health plan 7or health insurance coverage offered in connection with a group health plan7 described in subsection 7a7 that does not provide coverage for benefits outside of a network shall ensure that such provider network is adequate to ensure enrollee access to prosthetic and custom orthotic devices and related services provided by appropriately credentialed practitioners and accredited suppliers of prosthetics and custom orthotics4 7c7 ,additional requirements 7#a7 ,prior authorization ,in the case of a group health plan 7or health insurance coverage offered in connection with a group health plan7 that requires1 as a condition of coverage or payment for prosthetics or custom orthotics 7or both7 under the plan 7or coverage71 prior authorization1 such prior authorization must be required in the same manner as prior authorization is required by the plan 7or coverage7 as a condition of coverage or payment for all similar medical and surgical benefits provided under the plan 7or coverage74 7#b7 ,limitation on benefits ,coverage for required benefits for prosthetics and custom orthotics under this section may be limited to coverage of the most appropriate device or component model that meets the medical requirements of the patient1 as determined by the treating physician of the patient involved4 7#c7 ,coverage for repair or replacement ,benefits for prosthetics and custom orthotics required under this section shall include coverage for the repair or replacement of prosthetics and custom orthotics1 if the repair or replacement is due to normal wear and tear1 irreparable damage1 a change in the condition of the patient as determined by the treating physician1 or otherwise determined appropriate by the treating physician of the patient involved4 7d7 ,definitions ,in this section3 7#a7 ,prosthetics ,the term prosthetics means those devices and components that may be used to replace1 in whole or in part1 an arm or leg1 as well as the services required to do so and includes external breast prostheses incident to mastectomy resulting from breast cancer4 7#b7 ,custom orthotics ,the term custom orthotics means the following3 7,a7 ,custom-fabricated orthotics and related services1 which include custom-fabricated devices that are individually made for a specific patient1 as well as all services and supplies that are medically necessary for the effective use of the orthotic device and instructing the patient in the use of the device4 ,no other patient would be able to use this particular orthosis4 ,a custom-fabricated orthosis is a device which is fabricated based on clinically derived and rectified castings1 tracings1 measurements1 or other images 7such as x-rays7 of the body part4 ,the fabrication may involve using calculations1 templates and component parts4 ,this process requires the use of basic materials and involves substantial work such as vacuum forming1 cutting1 bending1 molding1 sewing1 drilling and finishing prior to fitting on the patient4 ,custom-fabricated devices may be furnished only by an appropriately credentialed 7certified or licensed7 practitioner and accredited supplier in ,orthotics or ,prosthetics4 ,such devices and related services are represented by the set of ,l-codes under the ,healthcare ,common ,procedure ,coding ,system describing this care listed on the date of enactment of this section in ,centers for ,medicare ,medicaid ,services ,transmittal #fef4 7,b7 ,custom-fitted high orthotics and related services1 which include prefabricated devices that are manufactured with no specific patient in mind1 but that are appropriately sized1 adapted1 modified1 and configured 7with the required tools and equipment7 to a specific patient in accordance with a prescription1 and which no other patient would be able to use1 as well as all services and supplies that are medically necessary for the effective use of the orthotic device and instructing the patient in the use of the device4 ,custom-fitted high devices may be furnished only by an appropriately credentialed 7certified or licensed7 practitioner and accredited supplier in ,orthotics or ,prosthetics4 ,such devices and related services are represented by the existing set of ,l-codes under the ,healthcare ,common ,procedure ,coding ,system describing this care listed on the date of enactment of this section in ,centers for ,medicare ,medicaid ,services ,transmittal #fef4 ,for purposes of subparagraphs 7,a7 and 7,b71 ,centers for ,medicare ,medicaid ,services ,transmittal #fef1 upon modification or reissuance by the ,centers for ,medicare ,medicaid ,services to reflect new code additions and coding changes for prosthetics and custom orthotics1 shall be the version of the ,transmittal used for purposes of such subparagraphs4 7#c7 ,financial requirements ,the term financial requirements includes deductibles1 coinsurance1 co-payments1 other cost sharing1 and limitations on the total amount that may be paid by a participant or beneficiary with respect to benefits under the plan or health insurance coverage4 7#d7 ,treatment limitations ,the term treatment limitations includes limits on the frequency of treatment1 number of visits1 specific prescribed components1 limits that are more broadly applicable to durable medical equipment1 or other similar limits on the amount1 duration1 or scope of treatment4 7e7 ,differentiation from ,durable ,medical ,equipment ,for purposes of this section1 prosthetics and custom orthotics shall be treated as distinct from durable medical equipment4 4 7#b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd is amended by inserting after the item relating to section #gad the following3 ,sec4 #gae4 ,additional market reforms4 ,sec4 #gaf4 ,prosthetics and custom orthotics parity4 4 7b7 ,,phsa 7#a7 ,in general ,title ,,xxvii of the ,public ,health ,service ,act is amended by inserting after section #bgbh of such ,act 7#db ,u4,s4,c4 #cjj;gg-#bh71 as redesignated by section #ajja7b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 the following3 #bgbi4 ,prosthetics and custom orthotics parity 7a7 ,in general ,in the case of a group health plan1 or a health insurance issuer offering group or individual health insurance coverage1 that provides medical and surgical benefits and also provides benefits for prosthetics or custom orthotics 7as defined under paragraphs 7#a7 and 7#b7 of subsection 7e77 7or both7-- 7#a7 such benefits for prosthetics or custom orthotics 7or both7 under the plan or coverage shall be provided under terms and conditions that are no less favorable than the terms and conditions applicable to substantially all medical and surgical benefits provided under the plan or coverage2 7#b7 such benefits for prosthetics or custom orthotics 7or both7 under the plan or coverage may not be subject to separate financial requirements 7as defined in subsection 7e77#b77 that are applicable only with respect to such benefits1 and any financial requirements applicable to such benefits shall be no more restrictive than the financial requirements applicable to substantially all medical and surgical benefits provided under the plan or coverage2 and 7#c7 any treatment limitations 7as defined in subsection 7e77#c77 applicable to such benefits for prosthetics or custom orthotics 7or both7 under the plan or coverage may not be more restrictive than the treatment limitations applicable to substantially all medical and surgical benefits provided under the plan or coverage4 7b7 ,patient access ,a group health plan1 or health insurance issuer offering group or individual health insurance coverage1 described in subsection 7a7 that does not provide coverage for benefits outside of a network shall ensure that such provider network is adequate to ensure enrollee access to prosthetic and custom orthotic devices and related services provided by appropriately credentialed practitioners and accredited suppliers of prosthetics and custom orthotics4 7c7 ,additional requirements 7#a7 ,prior authorization ,in the case of a group health plan1 or health insurance issuer offering group or individual health insurance coverage1 that requires1 as a condition of coverage or payment for prosthetics or custom orthotics 7or both7 under the plan or coverage1 prior authorization1 such prior authorization must be required in the same manner as prior authorization is required by the plan or coverage as a condition of coverage or payment for all similar medical and surgical benefits provided under the plan or coverage4 7#b7 ,limitation on benefits ,coverage for required benefits for prosthetics and custom orthotics under this section may be limited to coverage of the most appropriate device or component model that adequately meets the medical requirements of the patient1 as determined by the treating physician of the patient involved4 7#c7 ,coverage for repair or replacement ,benefits for prosthetics and custom orthotics required under this section shall include coverage for the repair or replacement of prosthetics and custom orthotics1 if the repair or replacement is due to normal wear and tear1 irreparable damage1 a change in the condition of the patient as determined by the treating physician1 or otherwise determined appropriate by the treating physician of the patient involved4 7d7 ,definitions ,in this section3 7#a7 ,prosthetics ,the term prosthetics means those devices and components that may be used to replace1 in whole or in part1 an arm or leg1 as well as the services required to do so and includes external breast prostheses incident to mastectomy resulting from breast cancer4 7#b7 ,custom orthotics ,the term custom orthotics means the following3 7,a7 ,custom-fabricated orthotics and related services1 which include custom-fabricated devices that are individually made for a specific patient1 as well as all services and supplies that are medically necessary for the effective use of the orthotic device and instructing the patient in the use of the device4 ,no other patient would be able to use this particular orthosis4 ,a custom-fabricated orthosis is a device which is fabricated based on clinically derived and rectified castings1 tracings1 measurements1 or other images 7such as x-rays7 of the body part4 ,the fabrication may involve using calculations1 templates and component parts4 ,this process requires the use of basic materials and involves substantial work such as vacuum forming1 cutting1 bending1 molding1 sewing1 drilling and finishing prior to fitting on the patient4 ,custom-fabricated devices may be furnished only by an appropriately credentialed 7certified or licensed7 practitioner and accredited supplier in ,orthotics or ,prosthetics4 ,such devices and related services are represented by the set of ,l-codes under the ,healthcare ,common ,procedure ,coding ,system describing this care listed on the date of enactment of this section in ,centers for ,medicare ,medicaid ,services ,transmittal #fef4 7,b7 ,custom-fitted high orthotics and related services1 which include prefabricated devices that are manufactured with no specific patient in mind1 but that are appropriately sized1 adapted1 modified1 and configured 7with the required tools and equipment7 to a specific patient in accordance with a prescription1 and which no other patient would be able to use1 as well as all services and supplies that are medically necessary for the effective use of the orthotic device and instructing the patient in the use of the device4 ,custom-fitted high devices may be furnished only by an appropriately credentialed 7certified or licensed7 practitioner and accredited supplier in ,orthotics or ,prosthetics4 ,such devices and related services are represented by the existing set of ,l-codes under the ,healthcare ,common ,procedure ,coding ,system describing this care listed on the date of enactment of this section in ,centers for ,medicare ,medicaid ,services ,transmittal #fef4 ,for purposes of subparagraphs 7,a7 and 7,b71 ,centers for ,medicare ,medicaid ,services ,transmittal #fef1 upon modification or reissuance by the ,centers for ,medicare ,medicaid ,services to reflect new code additions and coding changes for prosthetics and custom orthotics1 shall be the version of the ,transmittal used for purposes of such subparagraphs4 7#c7 ,financial requirements ,the term financial requirements includes deductibles1 coinsurance1 co-payments1 other cost sharing1 and limitations on the total amount that may be paid by a participant or beneficiary with respect to benefits under the plan or health insurance coverage4 7#d7 ,treatment limitations ,the term treatment limitations includes limits on the frequency of treatment1 number of visits1 specific prescribed components1 and limits that are more broadly applicable to durable medical equipment1 or other similar limits on the amount1 duration1 or scope of treatment4 7e7 ,differentiation from ,durable ,medical ,equipment ,for purposes of this section1 prosthetics and custom orthotics shall be treated as distinct from durable medical equipment4 4 7#b7 ,application to individual health insurance coverage before #bjad ,for purposes of applying section #bgbi of the ,public ,health ,service ,act1 as inserted by paragraph 7#a71 to individual health insurance coverage before #bjad1 the provisions of such section shall be treated as also included under part ,b of title ,,xxvii of the ,public ,health ,service ,act4 7c7 ,internal ,revenue ,code ,subchapter ,b of chapter #ajj of subtitle ,k of the ,internal ,revenue ,code of #aihf is amended by adding after section #ihac the following3 #ihad4 ,prosthetics and custom orthotics fairness in coverage 7a7 ,in general ,in the case of a group health plan 7or health insurance coverage offered in connection with a group health plan7 that provides medical and surgical benefits and also provides benefits for prosthetics or custom orthotics 7as defined under paragraphs 7#a7 and 7#b7 of subsection 7e77 7or both7-- 7#a7 such benefits for prosthetics or custom orthotics 7or both7 under the plan 7or coverage7 shall be provided under terms and conditions that are no less favorable than the terms and conditions applicable to substantially all medical and surgical benefits provided under the plan 7or coverage72 7#b7 such benefits for prosthetics or custom orthotics 7or both7 under the plan 7or coverage7 may not be subject to separate financial requirements 7as defined in subsection 7e77#b77 that are applicable only with respect to such benefits1 and any financial requirements applicable to such benefits shall be no more restrictive than the financial requirements applicable to substantially all medical and surgical benefits provided under the plan 7or coverage72 and 7#c7 any treatment limitations 7as defined in subsection 7e77#c77 applicable to such benefits for prosthetics or custom orthotics 7or both7 under the plan 7or coverage7 may not be more restrictive than the treatment limitations applicable to substantially all medical and surgical benefits provided under the plan 7or coverage74 7b7 ,patient access ,a group health plan 7or health insurance coverage offered in connection with a group health plan7 described in subsection 7a7 that does not provide coverage for benefits outside of a network shall ensure that such provider network is adequate to ensure enrollee access to prosthetic and custom orthotic devices and related services provided by appropriately credentialed practitioners and accredited suppliers of prosthetics and custom orthotics4 7c7 ,additional requirements 7#a7 ,prior authorization ,in the case of a group health plan 7or health insurance coverage offered in connection with a group health plan7 that requires1 as a condition of coverage or payment for prosthetics or custom orthotics 7or both7 under the plan 7or coverage71 prior authorization1 such prior authorization must be required in the same manner as prior authorization is required by the plan 7or coverage7 as a condition of coverage or payment for all similar medical and surgical benefits provided under the plan 7or coverage74 7#b7 ,limitation on benefits ,coverage for required benefits for prosthetics and custom orthotics under this section may be limited to coverage of the most appropriate device or component model that meets the medical requirements of the patient1 as determined by the treating physician of the patient involved4 7#c7 ,coverage for repair or replacement ,benefits for prosthetics and custom orthotics required under this section shall include coverage for the repair or replacement of prosthetics and custom orthotics1 if the repair or replacement is due to normal wear and tear1 irreparable damage1 a change in the condition of the patient as determined by the treating physician1 or otherwise determined appropriate by the treating physician of the patient involved4 7#d7 ,assistance to enrollees ,the ,secretary of the ,treasury1 in consultation with the ,secretary of ,health and ,human ,services1 shall provide assistance to enrollees under plans or coverage to which the amendment made by section #c apply with any questions or problems with respect to compliance with the requirements of such amendment4 7#e7 ,audits ,the ,secretary of the ,treasury1 in consultation with the ,secretary of ,health and ,human ,services1 shall provide for the conduct of random audits of group health plans 7and health insurance coverage offered in connection with such plans7 to ensure that such plans 7or coverage7 are in compliance with the amendments made by section 7#c74 7d7 ,definitions ,in this section3 7#a7 ,prosthetics ,the term prosthetics means those devices and components that may be used to replace1 in whole or in part1 an arm or leg1 as well as the services required to do so and includes external breast prostheses incident to mastectomy resulting from breast cancer4 7#b7 ,custom orthotics ,the term custom orthotics means the following3 7,a7 ,custom-fabricated orthotics and related services1 which include custom-fabricated devices that are individually made for a specific patient1 as well as all services and supplies that are medically necessary for the effective use of the orthotic device and instructing the patient in the use of the device4 ,no other patient would be able to use this particular orthosis4 ,a custom-fabricated orthosis is a device which is fabricated based on clinically derived and rectified castings1 tracings1 measurements1 or other images 7such as x-rays7 of the body part4 ,the fabrication may involve using calculations1 templates and component parts4 ,this process requires the use of basic materials and involves substantial work such as vacuum forming1 cutting1 bending1 molding1 sewing1 drilling and finishing prior to fitting on the patient4 ,custom-fabricated devices may be furnished only by an appropriately credentialed 7certified or licensed7 practitioner and accredited supplier in ,orthotics or ,prosthetics4 ,such devices and related services are represented by the set of ,l-codes under the ,healthcare ,common ,procedure ,coding ,system describing this care listed on the date of enactment of this section in ,centers for ,medicare ,medicaid ,services ,transmittal #fef4 7,b7 ,custom-fitted high orthotics and related services1 which include prefabricated devices that are manufactured with no specific patient in mind1 but that are appropriately sized1 adapted1 modified1 and configured 7with the required tools and equipment7 to a specific patient in accordance with a prescription1 and which no other patient would be able to use1 as well as all services and supplies that are medically necessary for the effective use of the orthotic device and instructing the patient in the use of the device4 ,custom-fitted high devices may be furnished only by an appropriately credentialed 7certified or licensed7 practitioner and accredited supplier in ,orthotics or ,prosthetics4 ,such devices and related services are represented by the existing set of ,l-codes under the ,healthcare ,common ,procedure ,coding ,system describing this care listed on the date of enactment of this section in ,centers for ,medicare ,medicaid ,services ,transmittal #fef4 ,for purposes of subparagraphs 7,a7 and 7,b71 ,centers for ,medicare ,medicaid ,services ,transmittal #fef1 upon modification or reissuance by the ,centers for ,medicare ,medicaid ,services to reflect new code additions and coding changes for prosthetics and custom orthotics1 shall be the version of the ,transmittal used for purposes of such subparagraphs4 7#c7 ,financial requirements ,the term financial requirements includes deductibles1 coinsurance1 co-payments1 other cost sharing1 and limitations on the total amount that may be paid by a participant or beneficiary with respect to benefits under the plan or health insurance coverage4 7#d7 ,treatment limitations ,the term treatment limitations includes limits on the frequency of treatment1 number of visits1 specific prescribed components1 or other similar limits on the scope or duration of treatment4 7e7 ,differentiation from ,durable ,medical ,equipment ,for purposes of this section1 prosthetics and custom orthotics shall be treated as distinct from durable medical equipment4 4 7d7 ,effective date ,the amendments made by this section shall apply with respect to plan years beginning on or after the date of the enactment of this section and with respect to health insurance coverage issued on or after such date4 #d4 ,updating standard definitions to include prosthetics and custom orthotics 7a7 ,in general ,section #bgae7;g77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ae7;g77#c77 is amended by inserting prosthetics1 custom orthotics1 after emergency medical transportation14 7b7 ,prosthetics2 custom orthotics ,in developing standards for the definitions of the terms prosthetics and custom orthotics pursuant to the amendment made by subsection 7a71 the ,secretary shall ensure that such definitions are consistent with the definitions of such terms in section #bgbi7;d7 of the ,public ,health ,service ,act 7as added by section #c7;b7 of this ,act74 #e4 ,federal administrative responsibilities 7a7 ,assistance to enrollees ,the ,secretary of ,labor1 in consultation with the ,secretary of ,health and ,human ,services1 shall provide assistance to enrollees under group health plans 7and health insurance coverage offered in connection with such plans7 to which the amendments made by section #c apply with any questions or problems with respect to compliance with the requirements of such amendments4 7b7 ,audits ,the ,secretary of ,labor1 in consultation with the ,secretary of ,health and ,human ,services1 shall provide for the conduct of random audits of group health plans 7and health insurance coverage offered in connection with such plans7 to ensure that such plans 7or coverage7 are in compliance with the amendments made by section #c4 7c7 ,regulations ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,labor1 in consultation with the ,secretary of ,health and ,human ,services1 shall promulgate final regulations to carry out this ,act and the amendments made by this ,act4 7d7 ,definitions ,in this section3 7#a7 ,group ,health ,plan ,the term group health plan has the meaning given such term in section #gcc7;a7 of the ,employee ,retirement and ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaia;b7a774 7#b7 ,health ,insurance ,coverage ,the term health insurance coverage has the meaning given such term in section #gcc7;b77#a7 of such ,act 7#bi ,u4,s4,c4 #aaia;b7b77#a774