,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #ccch  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bj1 #bjag,ms4  
,de,lauro 7= h]self1 ,ms4 ,wass]man     
,s*ultz1 ,ms4 ,cl>ke ( ,new ,york1 ,mr4 
,coh51 ,mr4 ,khanna1 ,mr4 ,l>s5 (       
,wa%+ton1 ,mr4 ,rupp]sb]g]1 ,mrs4       
,d+ell1 ,mr4 ,connolly1 ,mrs4 ,c>olyn   
,b4 ,maloney ( ,new ,york1 ,ms4         
,bordallo1 ,ms4 ,kaptur1 ,mr4 ,pocan1   
,mr4 ,takano1 ,mr4 ,y>mu?1 ,mr4 ,payne1 
,mr4 ,s]rano1 ,mr4 ,s*iff1 ,ms4         
,tsongas1 ,mrs4 ,napolitano1 ,mr4       
,grijalva1 ,ms4 ,mi*elle ,lujan ,gri%am 
( ,new ,mexico1 ,mr4 ,nadl]1 ,mr4       
,engel1 ,mr4 ,ryan ( ,ohio1 ,mr4 ,ha/+s1
 ,mr4 ,langev91 ,mr4 ,mc,govern1 ,mr4   
,ru%1 ,mr4 ,clyburn1 ,mr4 ,c>son (      
,indiana1 ,ms4 ,roybal-,all>d1 ,mr4     
,cicill9e1 & ,ms4 ,judy ,*u ( ,cali=nia7
 introduc$ ! foll[+ bill2 :i* 0 ref]r$  
to ! ,committee on ,en]gy & ,comm]ce1 & 
9 addition to ! ,committees on ,ways &  
,means1 & ,education & ! ,work=ce1 = a  
p]iod to be subsequ5tly det]m9$ by !    

,speak]1 9 ea* case = consid]ation ( su*
 provisions z fall )9 ! jurisdiction ( !
 committee conc]n$  ,a ,,bill  ,to      
require t heal? plans provide cov]age = 
a m9imum hospital /ay = ma/ectomies1    
lumpectomies1 & lymph node dissection = 
! treatm5t ( brea/ canc] & cov]age =    
second>y consultations4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,brea/ ,canc]
 ,pati5t ,protection ,act ( #bjag4  #b4 
,f9d+s ,congress f9ds ! foll[+3  7#a7   
,accord+ to ! ,national ,canc]          
,in/itute1 exclud+ canc]s ( ! sk91 brea/
 canc] is ! mo/ frequ5tly diagnos$ canc]
 9 wom54  7#b7 ,accord+ to ! ,national  
,canc] ,in/itute1 an e/imat$ #dj1faj    
wom5 & #dfj m5 w die f brea/ canc] 9    
#bjag4  7#c7 ,accord+ to ! ,national    
,canc] ,in/itute1 9 #bjag an e/imat$    
#beb1gaj new cases ( brea/ canc] w be   
diagnos$ 9 wom5 & an e/imat$ #b1dgj     
cases w be diagnos$ 9 m54  7#d7 ,accord+
 to ! ,am]ican ,canc] ,society1 mo/     
brea/ canc] pati5ts und]go "s type (    
surgical treatm5t1 :i* may involve      

lumpectomy or ma/ectomy ) removal ( "s (
 ! axill>y lymph nodes4  7#e7 ,! (f]+ & 
op]ation ( heal? plans affect comm]ce   
among ! ,/ates4  7#f7 ,heal? c>e        
provid]s locat$ 9 a ,/ate s]ve pati5ts  
:o reside 9 ! ,/ate & pati5ts :o reside 
9 o!r ,/ates4  7#g7 ,9 ord] to provide =
 uni=m treatm5t ( heal? c>e provid]s &  
pati5ts among ! ,/ates1 x is necess>y to
 cov] heal? plans op]at+ 9 "o ,/ate z   
well z heal? plans op]at+ among ! sev]al
 ,/ates4  7#h7 ,rese>* has indicat$ t   
treatm5t = brea/ canc] v>ies accord+ to 
type ( insurance cov]age & ,/ate (      
resid5ce4  7#i7 ,brea/ canc] pati5ts h  
report$ adv]se outcomes1 includ+        
infection & inadequately controll$ pa91 
result+ f premature hospital dis*>ge    
foll[+ brea/ canc] surg]y4  #c4         
,am5dm5ts to ! ,employee ,retirem5t     
,income ,security ,act ( #aigd  7a7 ,9  
g5]al ,subp>t ,b ( "p #g ( subtitle ,b (
 title ,i ( ! ,employee ,retirem5t      
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe et seq47 is am5d$ by    

add+ at ! end ! foll[+3  #gaf4 ,requir$ 
cov]age = m9imum hospital /ay =         
ma/ectomies1 lumpectomies1 & lymph node 
dissections = ! treatm5t ( brea/ canc] &
 cov]age = second>y consultations  7a7  
,inpati5t c>e  7#a7 ,9 g5]al ,a gr\p    
heal? plan1 & a heal? insurance issu]   
provid+ heal? insurance cov]age 9       
connection ) a gr\p heal? plan1 t       
provides m$ical & surgical b5efits %all 
ensure t inpati5t 7& 9 ! case ( a       
lumpectomy1 outpati5t7 cov]age &        
radiation !rapy is provid$ = brea/ canc]
 treatm5t4 ,su* plan or cov]age may n-- 
7,a7 ins(> z ! att5d+ physician1 9      
consultation ) ! pati5t1 det]m9es x to  
be m$ically necess>y--  7i7 re/rict     
b5efits = any hospital l5g? ( /ay 9     
connection ) a ma/ectomy or brea/       
cons]v+ surg]y 7su* z a lumpectomy7 = ! 
treatm5t ( brea/ canc] to less ?an #dh  
h\rs2 or  7ii7 re/rict b5efits = any    
hospital l5g? ( /ay 9 connection ) a    
lymph node dissection = ! treatm5t (    
brea/ canc] to less ?an #bd h\rs2 or    

7,b7 require t a provid] obta9          
au?orization f ! plan or ! issu] =      
prescrib+ any l5g? ( /ay requir$ "u ?is 
p>agraph4  7#b7 ,exception ,no?+ 9 ?is  
section %all be con/ru$ z requir+ !     
provision ( inpati5t cov]age if ! att5d+
 physician1 9 consultation ) ! pati5t1  
det]m9es t ei!r a %ort] p]iod ( hospital
 /ay1 or outpati5t treatm5t1 is m$ically
 appropriate4  7b7 ,prohibition on c]ta9
 modifications ,9 implem5t+ !           
requirem5ts ( ?is section1 a gr\p heal? 
plan1 & a heal? insurance issu] provid+ 
heal? insurance cov]age 9 connection ) a
 gr\p heal? plan1 may n modify ! t]ms & 
conditions ( cov]age bas$ on !          
det]m9ation by a p>ticipant or b5efici>y
 to reque/ less ?an ! m9imum cov]age    
requir$ "u subsection 7a74  7c7 ,notice 
,a gr\p heal? plan1 & a heal? insurance 
issu] provid+ heal? insurance cov]age 9 
connection ) a gr\p heal? plan1 %all    
provide notice to ea* p>ticipant &      
b5efici>y "u su* plan reg>d+ ! cov]age  
requir$ by ?is section 9 accordance )   

regulations promulgat$ by ! ,secret>y4  
,su* notice %all be 9 writ+ & prom95tly 
position$ 9 ! summ>y ( ! plan made      
available or di/ribut$ by ! plan or     
issu] & %all be transmitt$--  7#a7 9 !  
next mail+ made by ! plan or issu] to ! 
p>ticipant or b5efici>y2 or  7#b7 z "p (
 any ye>ly in=mational packet s5t to !  
p>ticipant or b5efici>y1  :i*ev] is     
e>li]4  7d7 ,second>y consultations     
7#a7 ,9 g5]al ,a gr\p heal? plan1 & a   
heal? insurance issu] provid+ heal?     
insurance cov]age 9 connection ) a gr\p 
heal? plan1 t provides cov]age ) respect
 to m$ical & surgical s]vices provid$ 9 
relation to ! diagnosis & treatm5t (    
canc] %all ensure t cov]age is provid$ =
 second>y consultations1 on t]ms &      
conditions t are no m re/rictive ?an ^? 
applicable to ! initial consultations1  
by speciali/s 9 ! appropriate m$ical    
fields 7includ+ pa?ology1 radiology1 &  
oncology7 to confirm or refute su*      
diagnosis4 ,su* plan or issu] %all      
ensure t cov]age is provid$ = su*       

second>y consultation :e!r su*          
consultation is bas$ on a positive or   
negative initial diagnosis4 ,9 any case 
9 :i* ! att5d+ physician c]tifies 9     
writ+ t s]vices necess>y = su* a        
second>y consultation are n suffici5tly 
available f speciali/s op]at+ "u ! plan 
) respect to ^: s]vices cov]age is      
o!rwise provid$ "u su* plan or by su*   
issu]1 su* plan or issu] %all ensure t  
cov]age is provid$ ) respect to !       
s]vices necess>y = ! second>y           
consultation ) any o!r speciali/ select$
 by ! att5d+ physician = su* purpose at 
no additional co/ to ! individual beyond
 t :i* ! individual w\ld h paid if !    
speciali/ 0 p>ticipat+ 9 ! network ( !  
plan4  7#b7 ,exception ,no?+ 9 p>agraph 
7#a7 %all be con/ru$ z requir+ !        
provision ( second>y consultations :]e !
 pati5t det]m9es n to seek su* a        
consultation4  7e7 ,prohibition on      
p5alties or inc5tives ,a gr\p heal?     
plan1 & a heal? insurance issu] provid+ 
heal? insurance cov]age 9 connection ) a

 gr\p heal? plan1 may n--  7#a7 p5alize 
or o!rwise r$uce or limit ! reimbursem5t
 ( a provid] or speciali/ because !     
provid] or speciali/ provid$ c>e to a   
p>ticipant or b5efici>y 9 accordance )  
?is section2  7#b7 provide f9ancial or  
o!r inc5tives to a physician or         
speciali/ to induce ! physician or      
speciali/ to keep ! l5g? ( inpati5t /ays
 ( pati5ts foll[+ a ma/ectomy1          
lumpectomy1 or a lymph node dissection =
 ! treatm5t ( brea/ canc] bel[ c]ta9    
limits or to limit ref]rals = second>y  
consultations2 or  7#c7 provide f9ancial
 or o!r inc5tives to a physician or     
speciali/ to induce ! physician or      
speciali/ to refra9 f ref]r+ a          
p>ticipant or b5efici>y = a second>y    
consultation t w\ld o!rwise be cov]$ by 
! plan or cov]age involv$ "u subsection 
7d74  4  7b7 ,cl]ical am5dm5t ,! table (
 cont5ts 9 section #a ( ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd is am5d$ by ins]t+ aft] ! item    
relat+ to section #gad ! foll[+3  ,sec4 

#gae4 ,additional m>ket re=ms4 ,sec4    
#gaf4 ,requir$ cov]age = m9imum hospital
 /ay = ma/ectomies1 lumpectomies1 &     
lymph node dissections = ! treatm5t (   
brea/ canc] & cov]age = second>y        
consultations4  4  7c7 ,effective dates 
7#a7 ,9 g5]al ,! am5dm5ts made by ?is   
section %all apply ) respect to plan    
ye>s beg9n+ on or aft] ! date t is #ij  
days aft] ! date ( enactm5t ( ?is ,act4 
7#b7 ,special rule = collective b>ga9+  
agreem5ts ,9 ! case ( a gr\p heal? plan 
ma9ta9$ pursuant to #a or m collective  
b>ga9+ agreem5ts betwe5 employee        
repres5tatives & #a or m employ]s       
ratifi$ be=e ! date ( enactm5t ( ?is    
,act1 ! am5dm5ts made by ?is section    
%all n apply to plan ye>s beg9n+ be=e ! 
date on :i* ! la/ collective b>ga9+     
agreem5ts relat+ to ! plan t]m9ates     
7det]m9$ )\t reg>d to any ext5sion !re( 
agre$ to aft] ! date ( enactm5t ( ?is   
,act74 ,= purposes ( ?is p>agraph1 any  
plan am5dm5t made pursuant to a         
collective b>ga9+ agreem5t relat+ to !  

plan :i* am5ds ! plan solely to con=m to
 any requirem5t add$ by ?is section %all
 n be treat$ z a t]m9ation ( su*        
collective b>ga9+ agreem5t4  #d4        
,am5dm5ts to ! ,public ,heal? ,s]vice   
,act  7a7 ,9 g5]al ,title ,,xxvii ( !   
,public ,heal? ,s]vice ,act is am5d$ by 
ins]t+ aft] section #bgbh ( su* ,act    
7#db ,u4,s4,c4 #cjj;gg-#bh71 z          
r$esignat$ by section #ajja7b7 ( !      
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh71 ! foll[+3 
#bgbi4 ,requir$ cov]age = m9imum        
hospital /ay = ma/ectomies1             
lumpectomies1 & lymph node dissections =
 ! treatm5t ( brea/ canc] & cov]age =   
second>y consultations  7a7 ,inpati5t   
c>e  7#a7 ,9 g5]al ,a gr\p heal? plan1 &
 a heal? insurance issu] provid+ gr\p or
 individual heal? insurance cov]age1 t  
provides m$ical & surgical b5efits %all 
ensure t inpati5t 7& 9 ! case ( a       
lumpectomy1 outpati5t7 cov]age &        
radiation !rapy is provid$ = brea/ canc]
 treatm5t4 ,su* plan or cov]age may n-- 

7,a7 ins(> z ! att5d+ physician1 9      
consultation ) ! pati5t1 det]m9es x to  
be m$ically necess>y--  7i7 re/rict     
b5efits = any hospital l5g? ( /ay 9     
connection ) a ma/ectomy or brea/       
cons]v+ surg]y 7su* z a lumpectomy7 = ! 
treatm5t ( brea/ canc] to less ?an #dh  
h\rs2 or  7ii7 re/rict b5efits = any    
hospital l5g? ( /ay 9 connection ) a    
lymph node dissection = ! treatm5t (    
brea/ canc] to less ?an #bd h\rs2 or    
7,b7 require t a provid] obta9          
au?orization f ! plan or ! issu] =      
prescrib+ any l5g? ( /ay requir$ "u ?is 
p>agraph4  7#b7 ,exception ,no?+ 9 ?is  
section %all be con/ru$ z requir+ !     
provision ( inpati5t cov]age if ! att5d+
 physician1 9 consultation ) ! pati5t1  
det]m9es t ei!r a %ort] p]iod ( hospital
 /ay1 or outpati5t treatm5t1 is m$ically
 appropriate4  7b7 ,prohibition on c]ta9
 modifications ,9 implem5t+ !           
requirem5ts ( ?is section1 a gr\p heal? 
plan1 & a heal? insurance issu] provid+ 
gr\p or individual heal? insurance      

cov]age1 may n modify ! t]ms &          
conditions ( cov]age bas$ on !          
det]m9ation by a p>ticipant or b5efici>y
 to reque/ less ?an ! m9imum cov]age    
requir$ "u subsection 7a74  7c7 ,notice 
,a gr\p heal? plan1 & a heal? insurance 
issu] provid+ gr\p or individual heal?  
insurance cov]age1 %all provide notice  
to ea* p>ticipant & b5efici>y "u su*    
plan or cov]age reg>d+ ! cov]age requir$
 by ?is section 9 accordance )          
regulations promulgat$ by ! ,secret>y4  
,su* notice %all be 9 writ+ & prom95tly 
position$ 9 ! summ>y ( ! plan or cov]age
 made available or di/ribut$ by ! plan  
or issu] & %all be transmitt$--  7#a7 9 
! next mail+ made by ! plan or issu] to 
! p>ticipant or b5efici>y2 or  7#b7 z "p
 ( any ye>ly in=mational packet s5t to !
 p>ticipant or b5efici>y1  :i*ev] is    
e>li]4  7d7 ,second>y consultations     
7#a7 ,9 g5]al ,a gr\p heal? plan1 & a   
heal? insurance issu] provid+ gr\p or   
individual heal? insurance cov]age1 t   
provides cov]age ) respect to m$ical &  

surgical s]vices provid$ 9 relation to !
 diagnosis & treatm5t ( canc] %all      
ensure t cov]age is provid$ = second>y  
consultations1 on t]ms & conditions t   
are no m re/rictive ?an ^? applicable to
 ! initial consultations1 by speciali/s 
9 ! appropriate m$ical fields 7includ+  
pa?ology1 radiology1 & oncology7 to     
confirm or refute su* diagnosis4 ,su*   
plan or issu] %all ensure t cov]age is  
provid$ = su* second>y consultation :e!r
 su* consultation is bas$ on a positive 
or negative initial diagnosis4 ,9 any   
case 9 :i* ! att5d+ physician c]tifies 9
 writ+ t s]vices necess>y = su* a       
second>y consultation are n suffici5tly 
available f speciali/s op]at+ "u ! plan 
or cov]age ) respect to ^: s]vices      
cov]age is o!rwise provid$ "u su* plan  
or by su* issu]1 su* plan or issu] %all 
ensure t cov]age is provid$ ) respect to
 ! s]vices necess>y = ! second>y        
consultation ) any o!r speciali/ select$
 by ! att5d+ physician = su* purpose at 
no additional co/ to ! individual beyond

 t :i* ! individual w\ld h paid if !    
speciali/ 0 p>ticipat+ 9 ! network ( !  
plan4  7#b7 ,exception ,no?+ 9 p>agraph 
7#a7 %all be con/ru$ z requir+ !        
provision ( second>y consultations :]e !
 pati5t det]m9es n to seek su* a        
consultation4  7e7 ,prohibition on      
p5alties or inc5tives ,a gr\p heal?     
plan1 & a heal? insurance issu] provid+ 
gr\p or individual heal? insurance      
cov]age1 may n--  7#a7 p5alize or       
o!rwise r$uce or limit ! reimbursem5t ( 
a provid] or speciali/ because ! provid]
 or speciali/ provid$ c>e to a          
p>ticipant or b5efici>y 9 accordance )  
?is section2  7#b7 provide f9ancial or  
o!r inc5tives to a physician or         
speciali/ to induce ! physician or      
speciali/ to keep ! l5g? ( inpati5t /ays
 ( pati5ts foll[+ a ma/ectomy1          
lumpectomy1 or a lymph node dissection =
 ! treatm5t ( brea/ canc] bel[ c]ta9    
limits or to limit ref]rals = second>y  
consultations2 or  7#c7 provide f9ancial
 or o!r inc5tives to a physician or     

speciali/ to induce ! physician or      
speciali/ to refra9 f ref]r+ a          
p>ticipant or b5efici>y = a second>y    
consultation t w\ld o!rwise be cov]$ by 
! plan or cov]age involv$ "u subsection 
7d74  4  7b7 ,effective dates  7#a7 ,9  
g5]al ,! am5dm5ts made by ?is section   
%all apply ) respect to plan ye>s beg9n+
 on or aft] #ij days aft] ! date (      
enactm5t ( ?is ,act4  7#b7 ,special rule
 = collective b>ga9+ agreem5ts ,9 ! case
 ( a gr\p heal? plan ma9ta9$ pursuant to
 #a or m collective b>ga9+ agreem5ts    
betwe5 employee repres5tatives & #a or m
 employ]s ratifi$ be=e ! date ( enactm5t
 ( ?is ,act1 ! am5dm5ts made by ?is     
section %all n apply to plan ye>s beg9n+
 be=e ! date on :i* ! la/ collective    
b>ga9+ agreem5ts relat+ to ! plan       
t]m9ates 7det]m9$ )\t reg>d to any      
ext5sion !re( agre$ to aft] ! date (    
enactm5t ( ?is ,act74 ,= purposes ( ?is 
p>agraph1 any plan am5dm5t made pursuant
 to a collective b>ga9+ agreem5t relat+ 
to ! plan :i* am5ds ! plan solely to    

con=m to any requirem5t add$ by ?is     
section %all n be treat$ z a t]m9ation (
 su* collective b>ga9+ agreem5t4  #e4   
,am5dm5ts to ! ,int]nal ,rev5ue ,code ( 
#aihf  7a7 ,9 g5]al ,sub*apt] ,b ( *apt]
 #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf
 is am5d$-- 7#a7 9 ! table ( sections1  
by ins]t+ aft] ! item relat+ to section 
#ihac ! foll[+3  ,sec4 #ihad4 ,requir$  
cov]age = m9imum hospital /ay =         
ma/ectomies1 lumpectomies1 & lymph node 
dissections = ! treatm5t ( brea/ canc] &
 cov]age = second>y consultations4  2  &
  7#b7 by ins]t+ aft] section #ihac !   
foll[+3  #ihad4 ,requir$ cov]age =      
m9imum hospital /ay = ma/ectomies1      
lumpectomies1 & lymph node dissections =
 ! treatm5t ( brea/ canc] & cov]age =   
second>y consultations  7a7 ,inpati5t   
c>e  7#a7 ,9 g5]al ,a gr\p heal? plan t 
provides m$ical & surgical b5efits %all 
ensure t inpati5t 7& 9 ! case ( a       
lumpectomy1 outpati5t7 cov]age &        
radiation !rapy is provid$ = brea/ canc]
 treatm5t4 ,su* plan may n--  7,a7 ins(>

 z ! att5d+ physician1 9 consultation ) 
! pati5t1 det]m9es x to be m$ically     
necess>y--  7i7 re/rict b5efits = any   
hospital l5g? ( /ay 9 connection ) a    
ma/ectomy or brea/ cons]v+ surg]y 7su* z
 a lumpectomy7 = ! treatm5t ( brea/     
canc] to less ?an #dh h\rs2 or  7ii7    
re/rict b5efits = any hospital l5g? (   
/ay 9 connection ) a lymph node         
dissection = ! treatm5t ( brea/ canc] to
 less ?an #bd h\rs2 or  7,b7 require t a
 provid] obta9 au?orization f ! plan =  
prescrib+ any l5g? ( /ay requir$ "u ?is 
p>agraph4  7#b7 ,exception ,no?+ 9 ?is  
section %all be con/ru$ z requir+ !     
provision ( inpati5t cov]age if ! att5d+
 physician1 9 consultation ) ! pati5t1  
det]m9es t ei!r a %ort] p]iod ( hospital
 /ay1 or outpati5t treatm5t1 is m$ically
 appropriate4  7b7 ,prohibition on c]ta9
 modifications ,9 implem5t+ !           
requirem5ts ( ?is section1 a gr\p heal? 
plan may n modify ! t]ms & conditions ( 
cov]age bas$ on ! det]m9ation by a      
p>ticipant or b5efici>y to reque/ less  

?an ! m9imum cov]age requir$ "u         
subsection 7a74  7c7 ,notice ,a gr\p    
heal? plan %all provide notice to ea*   
p>ticipant & b5efici>y "u su* plan      
reg>d+ ! cov]age requir$ by ?is section 
9 accordance ) regulations promulgat$ by
 ! ,secret>y4 ,su* notice %all be 9     
writ+ & prom95tly position$ 9 ! summ>y (
 ! plan made available or di/ribut$ by !
 plan & %all be transmitt$--  7#a7 9 !  
next mail+ made by ! plan to !          
p>ticipant or b5efici>y2 or  7#b7 z "p (
 any ye>ly in=mational packet s5t to !  
p>ticipant or b5efici>y1  :i*ev] is     
e>li]4  7d7 ,second>y consultations     
7#a7 ,9 g5]al ,a gr\p heal? plan t      
provides cov]age ) respect to m$ical &  
surgical s]vices provid$ 9 relation to !
 diagnosis & treatm5t ( canc] %all      
ensure t cov]age is provid$ = second>y  
consultations1 on t]ms & conditions t   
are no m re/rictive ?an ^? applicable to
 ! initial consultations1 by speciali/s 
9 ! appropriate m$ical fields 7includ+  
pa?ology1 radiology1 & oncology7 to     

confirm or refute su* diagnosis4 ,su*   
plan or issu] %all ensure t cov]age is  
provid$ = su* second>y consultation :e!r
 su* consultation is bas$ on a positive 
or negative initial diagnosis4 ,9 any   
case 9 :i* ! att5d+ physician c]tifies 9
 writ+ t s]vices necess>y = su* a       
second>y consultation are n suffici5tly 
available f speciali/s op]at+ "u ! plan 
) respect to ^: s]vices cov]age is      
o!rwise provid$ "u su* plan or by su*   
issu]1 su* plan or issu] %all ensure t  
cov]age is provid$ ) respect to !       
s]vices necess>y = ! second>y           
consultation ) any o!r speciali/ select$
 by ! att5d+ physician = su* purpose at 
no additional co/ to ! individual beyond
 t :i* ! individual w\ld h paid if !    
speciali/ 0 p>ticipat+ 9 ! network ( !  
plan4  7#b7 ,exception ,no?+ 9 p>agraph 
7#a7 %all be con/ru$ z requir+ !        
provision ( second>y consultations :]e !
 pati5t det]m9es n to seek su* a        
consultation4  7e7 ,prohibition on      
p5alties ,a gr\p heal? plan may n-- 7#a7

 p5alize or o!rwise r$uce or limit !    
reimbursem5t ( a provid] or speciali/   
because ! provid] or speciali/ provid$  
c>e to a p>ticipant or b5efici>y 9      
accordance ) ?is section2  7#b7 provide 
f9ancial or o!r inc5tives to a physician
 or speciali/ to induce ! physician or  
speciali/ to keep ! l5g? ( inpati5t /ays
 ( pati5ts foll[+ a ma/ectomy1          
lumpectomy1 or a lymph node dissection =
 ! treatm5t ( brea/ canc] bel[ c]ta9    
limits or to limit ref]rals = second>y  
consultations2 or  7#c7 provide f9ancial
 or o!r inc5tives to a physician or     
speciali/ to induce ! physician or      
speciali/ to refra9 f ref]r+ a          
p>ticipant or b5efici>y = a second>y    
consultation t w\ld o!rwise be cov]$ by 
! plan involv$ "u subsection 7d74  4    
7b7 ,effective dates  7#a7 ,9 g5]al ,!  
am5dm5ts made by ?is section %all apply 
) respect to plan ye>s beg9n+ on or aft]
 ! date ( enactm5t ( ?is ,act4  7#b7    
,special rule = collective b>ga9+       
agreem5ts ,9 ! case ( a gr\p heal? plan 

ma9ta9$ pursuant to #a or m collective  
b>ga9+ agreem5ts betwe5 employee        
repres5tatives & #a or m employ]s       
ratifi$ be=e ! date ( enactm5t ( ?is    
,act1 ! am5dm5ts made by ?is section    
%all n apply to plan ye>s beg9n+ be=e ! 
date on :i* ! la/ collective b>ga9+     
agreem5ts relat+ to ! plan t]m9ates     
7det]m9$ )\t reg>d to any ext5sion !re( 
agre$ to aft] ! date ( enactm5t ( ?is   
,act74 ,= purposes ( ?is p>agraph1 any  
plan am5dm5t made pursuant to a         
collective b>ga9+ agreem5t relat+ to !  
plan :i* am5ds ! plan solely to con=m to
 any requirem5t add$ by ?is section %all
 n be treat$ z a t]m9ation ( su*        
collective b>ga9+ agreem5t4  #f4        
,opportunity = indep5d5t1 ext]nal ?ird  
p>ty reviews ( c]ta9 nonr5ewals &       
discont9uations1 includ+ rescissions1 ( 
individual heal? insurance cov]age  7a7 
,cl>ification reg>d+ application (      
gu>ante$ r5ewability ( individual heal? 
insurance cov]age ,section #bgdb ( !    
,public ,heal? ,s]vice ,act 7#db        

,u4,s4,c4 #cjj;gg-#db7 is am5d$-- 7#a7 9
 its head+1 by ins]t+ & cont9uation 9   
=ce1 includ+ prohibition ( rescission1  
aft] ,gu>ante$ r5ewability2  7#b7 9     
subsection 7a71 by ins]t+ 1 includ+ )\t 
rescission1 aft] cont9ue 9 =ce2 &  7#c7 
9 subsection 7b77#b71 by ins]t+ be=e !  
p]iod at ! end ! foll[+3 1 includ+      
int5tional concealm5t ( mat]ial facts   
reg>d+ a heal? condition relat$ to !    
condition = :i* cov]age is be+ claim$4  
7b7 ,opportunity = indep5d5t1 ext]nal   
?ird p>ty review 9 c]ta9 cases ,subp>t  
#a ( "p ,b ( title ,,xxvii ( ! ,public  
,heal? ,s]vice ,act is am5d$ by add+ at 
! end ! foll[+ new section3  #bgdf4     
,opportunity = indep5d5t1 ext]nal ?ird  
p>ty review 9 c]ta9 cases  7a7 ,notice &
 review "r ,if a heal? insurance issu]  
det]m9es to nonr5ew or n cont9ue 9 =ce1 
includ+ resc9d1 heal? insurance cov]age 
= an individual 9 ! individual m>ket on 
! basis describ$ 9 section #bgdb7;b77#b7
 be=e su* nonr5ewal1 discont9uation1 or 
rescission1 may take effect ! issu] %all

 provide ! individual ) notice ( su*    
propos$ nonr5ewal1 discont9uation1 or   
rescission & an opportunity = a review (
 su* det]m9ation by an indep5d5t1       
ext]nal ?ird p>ty "u proc$ures specifi$ 
by ! ,secret>y4  7b7 ,indep5d5t         
det]m9ation ,if ! individual reque/s su*
 review by an indep5d5t1 ext]nal ?ird   
p>ty ( a nonr5ewal1 discont9uation1 or  
rescission ( heal? insurance cov]age1 ! 
cov]age %all rema9 9 effect until su*   
?ird p>ty det]m9es t ! cov]age may be   
nonr5ew$1 discont9u$1 or resc9d$ "u     
section #bgdb7;b77#b74  4  7c7          
,effective date ,! am5dm5ts made by ?is 
section %all apply aft] ! date ( !      
enactm5t ( ?is ,act ) respect to heal?  
insurance cov]age issu$ be=e1 on1 or    
aft] su* date4