,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #fib  ,,in ,,the ,,house ,,of   
,,representatives  ,january #ah1        
#bjai,mr4 ,walden introduced the        
following bill2 which was referred to   
the ,committee on ,energy and ,commerce1
 and in addition to the ,committees on  
,education and ,labor1 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 ,public ,health ,service ,act 
to prohibit application of pre-existing 
condition exclusions and to guarantee   
availability of health insurance        
coverage in the individual and group    
market1 contingent on the enactment of  
legislation repealing the ,patient      
,protection and ,affordable ,care ,act1 
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,pre-existing ,conditions ,protection   
,act of #bjai4  #b4 ,prohibition of     

pre-existing condition exclusions  7a7  
,group market ,subject to section #f7;a7
 of this ,act1 subpart #a of part ,a of 
title ,,xxvii of the ,public ,health    
,service ,act 7#db ,u4,s4,c4 #cjj;gg et 
seq471 as restored or revived pursuant  
to ,,ppaca repeal legislation described 
in section #f7;b7 of this ,act1 is      
amended by striking section #bgja and   
inserting the following3  #bgja4        
,prohibition of pre-existing condition  
exclusions  7a7 ,in ,general ,a group   
health plan or a health insurance issuer
 offering group health insurance        
coverage may not impose any pre-existing
 condition exclusion with respect to    
such plan or coverage4  7b7 ,definitions
 ,for purposes of this section3 7#a7    
pre-existing condition exclusion  7,a7  
,in general ,the term pre-existing      
condition exclusion means1 with respect 
to a group health plan or health        
insurance coverage1 a limitation or     
exclusion of benefits relating to a     
condition based on the fact that the    

condition was present before the date of
 enrollment in such plan or for such    
coverage1 whether or not any medical    
advice1 diagnosis1 care1 or treatment   
was recommended or received before such 
date4  7,b7 ,treatment of genetic       
information ,genetic information shall  
not be treated as a pre-existing        
condition in the absence of a diagnosis 
of the condition related to such        
information4  7#b7 ,date of enrollment  
,the term date of enrollment means1 with
 respect to an individual covered under 
a group health plan or health insurance 
coverage1 the date of enrollment of the 
individual in the plan or coverage or1  
if earlier1 the first day of the waiting
 period for such enrollment4  7#c7      
,waiting period ,the term waiting period
 means1 with respect to a group health  
plan and an individual who is a         
potential participant or beneficiary in 
the plan1 the period that must pass with
 respect to the individual before the   
individual is eligible to be covered for

 benefits under the terms of the plan4  
4  7b7 ,individual market ,subject to   
section #f7;a7 of this ,act1 subpart #a 
of part ,b of title ,,xxvii of the      
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#da et seq471 as      
restored or revived pursuant to ,,ppaca 
repeal legislation described in section 
#f7;b7 of this ,act1 is amended by      
adding at the end the following3  #bgdf4
 ,prohibition of pre-existing condition 
exclusions or other discrimination based
 on health status ,the provisions of    
section #bgja shall apply to health     
insurance coverage offered to           
individuals by a health insurance issuer
 in the individual market in the same   
manner as it applies to health insurance
 coverage offered by a health insurance 
issuer in the group market4  4  #c4     
,guaranteed availability of coverage    
7a7 ,group market ,subject to section   
#f7;a7 of this ,act1 subpart #c of part 
,a of title ,,xxvii of the ,public      
,health ,service ,act1 as restored or   

revived pursuant to ,,ppaca repeal      
legislation described in section #f7;b7 
of this ,act1 is amended by striking    
section #bgaa 7#db ,u4,s4,c4            
#cjj;gg-#aa7 and inserting the          
following3  #bgaa4 ,guaranteed          
availability of coverage  7a7           
,guaranteed issuance of coverage in the 
group market ,subject to subsection 7b71
 each health insurance issuer that      
offers health insurance coverage in the 
group market in a ,state shall accept   
every employer and every individual in a
 group in the ,state that applies for   
such coverage4  7b7 ,enrollment  7#a7   
,restriction ,a health insurance issuer 
described in subsection 7a7 may restrict
 enrollment in coverage described in    
such subsection to open or special      
enrollment periods4  7#b7 ,establishment
 ,a health insurance issuer described in
 subsection 7a7 shall establish special 
enrollment periods for qualifying events
 7as such term is defined in section    
#fjc of the ,employee ,retirement       

,income ,security ,act of #aigd74  4    
7b7 ,individual market ,subject to      
section #f7;a7 of this ,act1 subpart #a 
of part ,b of title ,,xxvii of the      
,public ,health ,service ,act1 as       
restored or revived pursuant to ,,ppaca 
repeal legislation described in section 
#f7;b7 of this ,act1 is amended by      
striking section #bgda of such ,act 7#db
 ,u4,s4,c4 #cjj;gg-#da7 and inserting   
the following3  #bgda4 ,guaranteed      
availability of coverage ,the provisions
 of section #bgaa shall apply to health 
insurance coverage offered to           
individuals by a health insurance issuer
 in the individual market in the same   
manner as such provisions apply to      
health insurance coverage offered to    
employers by a health insurance issuer  
in connection with health insurance     
coverage in the group market4 ,for      
purposes of this section1 the ,secretary
 shall treat any reference of the word  
employer in such section as a reference 
to the term individual4  4  #d4         

,prohibiting discrimination against     
individual participants and             
beneficiaries based on health status    
7a7 ,group market ,subject to section   
#f7;a7 of this ,act1 section #bgjb of   
the ,public ,health ,service ,act1 as   
restored or revived pursuant to ,,ppaca 
repeal legislation described in section 
#f7;b7 of this ,act1 is amended to read 
as follows3  #bgjb4 ,prohibiting        
discrimination against individual       
participants and beneficiaries based on 
health status  7a7 ,in ,general ,a group
 health plan and a health insurance     
issuer offering group health insurance  
coverage may not establish rules for    
eligibility 7including continued        
eligibility7 of any individual to enroll
 under the terms of the plan or coverage
 based on any of the following health   
status-related factors in relation to   
the individual or a dependent of the    
individual3  7#a7 ,health status4  7#b7 
,medical condition 7including both      
physical and mental illnesses74  7#c7   

,claims experience4  7#d7 ,receipt of   
health care4  7#e7 ,medical history4    
7#f7 ,genetic information4  7#g7        
,evidence of insurability 7including    
conditions arising out of acts of       
domestic violence74  7#h7 ,disability4  
7#i7 ,any other health status-related   
factor determined appropriate by the    
,secretary4  7b7 ,in ,premium           
,contributions  7#a7 ,in general ,a     
group health plan1 and a health         
insurance issuer offering group health  
insurance coverage1 may not require any 
individual 7as a condition of enrollment
 or continued enrollment under the plan7
 to pay a premium or contribution which 
is greater than such premium or         
contribution for a similarly situated   
individual enrolled in the plan on the  
basis of any health status-related      
factor in relation to the individual or 
to an individual enrolled under the plan
 as a dependent of the individual4  7#b7
 ,construction ,nothing in paragraph    
7#a7 shall be construed-- 7,a7 to       

restrict the amount that an employer or 
individual may be charged for coverage  
under a group health plan except as     
provided in paragraph 7#c72 or  7,b7 to 
prevent a group health plan1 and a      
health insurance issuer offering group  
health insurance coverage1 from         
establishing premium discounts or       
rebates or modifying otherwise          
applicable copayments or deductibles in 
return for adherence to programs of     
health promotion and disease prevention4
  7#c7 ,no group-based discrimination on
 basis of genetic information  7,a7 ,in 
general ,for purposes of this section1 a
 group health plan1 and health insurance
 issuer offering group health insurance 
coverage1 may not adjust premium or     
contribution amounts for the group      
covered under such plan on the basis of 
genetic information4  7,b7 ,rule of     
construction ,nothing in subparagraph   
7,a7 or in paragraphs 7#a7 and 7#b7 of  
subsection 7d7 shall be construed to    
limit the ability of a health insurance 

issuer offering group health insurance  
coverage to increase the premium for an 
employer based on the manifestation of a
 disease or disorder of an individual   
who is enrolled in the plan4 ,in such   
case1 the manifestation of a disease or 
disorder in one individual cannot also  
be used as genetic information about    
other group members and to further      
increase the premium for the employer4  
7c7 ,genetic ,testing  7#a7 ,limitation 
on requesting or requiring genetic      
testing ,a group health plan1 and a     
health insurance issuer offering health 
insurance coverage in connection with a 
group health plan1 shall not request or 
require an individual or a family member
 of such individual to undergo a genetic
 test4  7#b7 ,rule of construction      
,paragraph 7#a7 shall not be construed  
to limit the authority of a health care 
professional who is providing health    
care services to an individual to       
request that such individual undergo a  
genetic test4  7#c7 ,rule of            

construction regarding payment  7,a7 ,in
 general ,nothing in paragraph 7#a7     
shall be construed to preclude a group  
health plan1 or a health insurance      
issuer offering health insurance        
coverage in connection with a group     
health plan1 from obtaining and using   
the results of a genetic test in making 
a determination regarding payment 7as   
such term is defined for the purposes of
 applying the regulations promulgated by
 the ,secretary under part ,c of title  
,,xi of the ,social ,security ,act and  
section #bfd of the ,health ,insurance  
,portability and ,accountability ,act of
 #aiif1 as may be revised from time to  
time7 consistent with subsection 7a74   
7,b7 ,limitation ,for purposes of       
subparagraph 7,a71 a group health plan1 
or a health insurance issuer offering   
health insurance coverage in connection 
with a group health plan1 may request   
only the minimum amount of information  
necessary to accomplish the intended    
purpose4  7#d7 ,research exception      

,notwithstanding paragraph 7#a71 a group
 health plan1 or a health insurance     
issuer offering health insurance        
coverage in connection with a group     
health plan1 may request1 but not       
require1 that a participant or          
beneficiary undergo a genetic test if   
each of the following conditions is met3
  7,a7 ,the request is made pursuant to 
research that complies with part #df of 
title #de1 ,code of ,federal            
,regulations1 or equivalent ,federal    
regulations1 and any applicable ,state  
or local law or regulations for the     
protection of human subjects in         
research4  7,b7 ,the plan or issuer     
clearly indicates to each participant or
 beneficiary1 or in the case of a minor 
child1 to the legal guardian of such    
beneficiary1 to whom the request is made
 that--  7i7 compliance with the request
 is voluntary2 and  7ii7 non-compliance 
will have no effect on enrollment status
 or premium or contribution amounts4    
7,c7 ,no genetic information collected  

or acquired under this paragraph shall  
be used for underwriting purposes4  7,d7
 ,the plan or issuer notifies the       
,secretary in writing that the plan or  
issuer is conducting activities pursuant
 to the exception provided for under    
this paragraph1 including a description 
of the activities conducted4  7,e7 ,the 
plan or issuer complies with such other 
conditions as the ,secretary may by     
regulation require for activities       
conducted under this paragraph4  7d7    
,prohibition on ,collection of ,genetic 
,information  7#a7 ,in general ,a group 
health plan1 and a health insurance     
issuer offering health insurance        
coverage in connection with a group     
health plan1 shall not request1 require1
 or purchase genetic information for    
underwriting purposes 7as defined in    
section #bgia74  7#b7 ,prohibition on   
collection of genetic information prior 
to enrollment ,a group health plan1 and 
a health insurance issuer offering      
health insurance coverage in connection 

with a group health plan1 shall not     
request1 require1 or purchase genetic   
information with respect to any         
individual prior to such individual's   
enrollment under the plan or coverage in
 connection with such enrollment4  7#c7 
,incidental collection ,if a group      
health plan1 or a health insurance      
issuer offering health insurance        
coverage in connection with a group     
health plan1 obtains genetic information
 incidental to the requesting1          
requiring1 or purchasing of other       
information concerning any individual1  
such request1 requirement1 or purchase  
shall not be considered a violation of  
paragraph 7#b7 if such request1         
requirement1 or purchase is not in      
violation of paragraph 7#a74  7e7       
,genetic ,information of a ,fetus or    
,embryo ,any reference in this part to  
genetic information concerning an       
individual or family member of an       
individual shall--  7#a7 with respect to
 such an individual or family member of 

an individual who is a pregnant woman1  
include genetic information of any fetus
 carried by such pregnant woman2 and    
7#b7 with respect to an individual or   
family member utilizing an assisted     
reproductive technology1 include genetic
 information of any embryo legally held 
by the individual or family member4  7f7
 ,programs of ,health ,promotion or     
,disease ,prevention  7#a7 ,general     
provisions  7,a7 ,general rule ,for     
purposes of subsection 7b77#b77;,b71 a  
program of health promotion or disease  
prevention 7referred to in this         
subsection as a wellness program7 shall 
be a program offered by an employer that
 is designed to promote health or       
prevent disease that meets the          
applicable requirements of this         
subsection4  7,b7 ,no conditions based  
on health status factor ,if none of the 
conditions for obtaining a premium      
discount or rebate or other reward for  
participation in a wellness program is  
based on an individual satisfying a     

standard that is related to a health    
status factor1 such wellness program    
shall not violate this section if       
participation in the program is made    
available to all similarly situated     
individuals and the requirements of     
paragraph 7#b7 are complied with4  7,c7 
,conditions based on health status      
factor ,if any of the conditions for    
obtaining a premium discount or rebate  
or other reward for participation in a  
wellness program is based on an         
individual satisfying a standard that is
 related to a health status factor1 such
 wellness program shall not violate this
 section if the requirements of         
paragraph 7#c7 are complied with4  7#b7 
,wellness programs not subject to       
requirements ,if none of the conditions 
for obtaining a premium discount or     
rebate or other reward under a wellness 
program as described in paragraph       
7#a77;,b7 are based on an individual    
satisfying a standard that is related to
 a health status factor 7or if such a   

wellness program does not provide such a
 reward71 the wellness program shall not
 violate this section if participation  
in the program is made available to all 
similarly situated individuals4 ,the    
following programs shall not have to    
comply with the requirements of         
paragraph 7#c7 if participation in the  
program is made available to all        
similarly situated individuals3  7,a7 ,a
 program that reimburses all or part of 
the cost for memberships in a fitness   
center4  7,b7 ,a diagnostic testing     
program that provides a reward for      
participation and does not base any part
 of the reward on outcomes4  7,c7 ,a    
program that encourages preventive care 
related to a health condition through   
the waiver of the copayment or          
deductible requirement under group      
health plan for the costs of certain    
items or services related to a health   
condition 7such as prenatal care or     
well-baby visits74  7,d7 ,a program that
 reimburses individuals for the costs of

 smoking cessation programs without     
regard to whether the individual quits  
smoking4  7,e7 ,a program that provides 
a reward to individuals for attending a 
periodic health education seminar4  7#c7
 ,wellness programs subject to          
requirements ,if any of the conditions  
for obtaining a premium discount1       
rebate1 or reward under a wellness      
program as described in paragraph       
7#a77;,c7 is based on an individual     
satisfying a standard that is related to
 a health status factor1 the wellness   
program shall not violate this section  
if the following requirements are       
complied with3  7,a7 ,the reward for the
 wellness program1 together with the    
reward for other wellness programs with 
respect to the plan that requires       
satisfaction of a standard related to a 
health status factor1 shall not exceed  
#cj percent of the cost of employee-only
 coverage under the plan4 ,if1 in       
addition to employees or individuals1   
any class of dependents 7such as spouses

 or spouses and dependent children7 may 
participate fully in the wellness       
program1 such reward shall not exceed   
#cj percent of the cost of the coverage 
in which an employee or individual and  
any dependents are enrolled4 ,for       
purposes of this paragraph1 the cost of 
coverage shall be determined based on   
the total amount of employer and        
employee contributions for the benefit  
package under which the employee is 7or 
the employee and any dependents are7    
receiving coverage4 ,a reward may be in 
the form of a discount or rebate of a   
premium or contribution1 a waiver of all
 or part of a cost-sharing mechanism    
7such as deductibles1 copayments1 or    
coinsurance71 the absence of a          
surcharge1 or the value of a benefit    
that would otherwise not be provided    
under the plan4 ,the ,secretaries of    
,labor1 ,health and ,human ,services1   
and the ,treasury may increase the      
reward available under this subparagraph
 to up to #ej percent of the cost of    

coverage if the ,secretaries determine  
that such an increase is appropriate4   
7,b7 ,the wellness program shall be     
reasonably designed to promote health or
 prevent disease4 ,a program complies   
with the preceding sentence if the      
program has a reasonable chance of      
improving the health of1 or preventing  
disease in1 participating individuals   
and it is not overly burdensome1 is not 
a subterfuge for discriminating based on
 a health status factor1 and is not     
highly suspect in the method chosen to  
promote health or prevent disease4  7,c7
 ,the plan shall give individuals       
eligible for the program the opportunity
 to qualify for the reward under the    
program at least once each year4  7,d7  
,the full reward under the wellness     
program shall be made available to all  
similarly situated individuals4 ,for    
such purpose1 among other things3  7i7  
,the reward is not available to all     
similarly situated individuals for a    
period unless the wellness program      

allows--  7,i7 for a reasonable         
alternative standard 7or waiver of the  
otherwise applicable standard7 for      
obtaining the reward for any individual 
for whom1 for that period1 it is        
unreasonably difficult due to a medical 
condition to satisfy the otherwise      
applicable standard2 and  7,,ii7 for a  
reasonable alternative standard 7or     
waiver of the otherwise applicable      
standard7 for obtaining the reward for  
any individual for whom1 for that       
period1 it is medically inadvisable to  
attempt to satisfy the otherwise        
applicable standard4  7ii7 ,if          
reasonable under the circumstances1 the 
plan or issuer may seek verification1   
such as a statement from an individual's
 physician1 that a health status factor 
makes it unreasonably difficult or      
medically inadvisable for the individual
 to satisfy or attempt to satisfy the   
otherwise applicable standard4  7,e7    
,the plan or issuer involved shall      
disclose in all plan materials          

describing the terms of the wellness    
program the availability of a reasonable
 alternative standard 7or the           
possibility of waiver of the otherwise  
applicable standard7 required under     
subparagraph 7,d74 ,if plan materials   
disclose that such a program is         
available1 without describing its terms1
 the disclosure under this subparagraph 
shall not be required4  7g7 ,existing   
,programs ,nothing in this section shall
 prohibit a program of health promotion 
or disease prevention that was          
established prior to the date of        
enactment of this section and applied   
with all applicable regulations1 and    
that is operating on such date1 from    
continuing to be carried out for as long
 as such regulations remain in effect4  
7h7 ,regulations ,nothing in this       
section shall be construed as           
prohibiting the ,secretaries of ,labor1 
,health and ,human ,services1 or the    
,treasury from promulgating regulations 
in connection with this section4  4  7b7

 ,individual market ,subject to section 
#f7;a7 of this ,act1 subpart #a of part 
,b of title ,,xxvii of the ,public      
,health ,service ,act1 as restored or   
revived pursuant to ,,ppaca repeal      
legislation described in section #f7;b7 
of this ,act and amended by section     
#b7;b71 is further amended by adding at 
the end the following3  #bgdg4          
,prohibiting discrimination against     
individual participants and             
beneficiaries based on health status    
,the provisions of section #bgjb 7other 
than subsections 7b77#b77;,b7 and 7f7 of
 such section7 shall apply to health    
insurance coverage offered to           
individuals by a health insurance issuer
 in the individual market in the same   
manner as such provisions apply to      
health insurance coverage offered to    
employers by a health insurance issuer  
in connection with health insurance     
coverage in the group market4  4  #e4   
,incorporation into ,,erisa and         
,internal ,revenue ,code  7a7 ,,erisa   

,subpart ,b of part #g of subtitle ,a of
 title ,i of the ,employee ,retirement  
,income ,security ,act of #aigd 7#bi    
,u4,s4,c4 #aaha et seq47 is amended by  
adding at the end the following3  #gae4 
,additional market reforms ,sections    
#bgja1 #bgjb1 and #bgaa shall apply to  
group health plans1 and health insurance
 issuers providing health insurance     
coverage in connection with group health
 plans1 as if included in this subpart1 
and to the extent that any provision of 
this part conflicts with a provision of 
such a section with respect to group    
health plans1 or health insurance       
issuers providing health insurance      
coverage in connection with group health
 plans1 the provisions of such section  
shall apply4  4  7b7 ,,irc ,subchapter  
,b of chapter #ajj of the ,internal     
,revenue ,code of #aihf is amended by   
adding at the end the following3  #ihae4
 ,additional market reforms ,sections   
#bgja1 #bgjb1 and #bgaa shall apply to  
group health plans1 and health insurance

 issuers providing health insurance     
coverage in connection with group health
 plans1 as if included in this          
subchapter1 and to the extent that any  
provision of this subchapter conflicts  
with a provision of such a section with 
respect to group health plans1 or health
 insurance issuers providing health     
insurance coverage in connection with   
group health plans1 the provisions of   
such section shall apply4  4  #f4       
,effective date contingent on repeal of 
,,ppaca  7a7 ,in general ,sections #b1  
#c1 #d1 and #e and the amendments made  
by such sections shall take effect upon 
the enactment of ,,ppaca repeal         
legislation described in subsection 7b7 
and such sections and amendments shall  
have no force or effect if such ,,ppaca 
repeal legislation is not enacted4  7b7 
,,ppaca repeal legislation described    
,for purposes of subsection 7a71 ,,ppaca
 repeal legislation described in this   
subsection is legislation that--  7#a7  
repeals ,public ,law #aaa-adh1 and      

restores or revives the provisions of   
law amended or repealed1 respectively1  
by such ,act as if such ,act had not    
been enacted and without further        
amendment to such provisions of law2 and
  7#b7 repeals title ,i and subtitle ,b 
of title ,,ii of the ,health ,care and  
,education ,reconciliation ,act of #bjaj
 7,public ,law #aaa-aeb71 and restores  
or revives the provisions of law amended
 or repealed1 respectively1 by such     
title or subtitle1 respectively1 as if  
such title and subtitle had not been    
enacted and without further amendment to
 such provisions of law4