,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #cecf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #ai1 #bjbj,mr4    
,casey 7= himself1 ,mr4 ,book]1 & ,mr4  
,re$7 introduc$ ! foll[+ bill2 :i* 0    
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to provide =       
special enrollm5t p]iods dur+ public    
heal? em]g5cies1 cov]age ( s]vices      
relat$ to public heal? em]g5cies1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,ensur+ ,cov]age 9     
,public ,heal? ,em]g5cies ,act ( #bjbj4 
#b4 ,special enrollm5t p]iods dur+      
public heal? em]g5cies  7a7 ,public     
,heal? ,s]vice ,act ,title ,,xxvii ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg et seq47 is am5d$--   
7#a7 9 section #bgjb7;b77#b7 7#db       
,u4,s4,c4 #cjj;gg-#a7;b77#b771 by ins]t+
 1 :i* %all include a special enrollm5t 
p]iod ( #cj days dur+ a public heal?    
em]g5cy decl>$ "u section #cai1 :i*     
p]iod may be ext5d$ = su* "t z !        
,secret>y may require be=e ! p]iod at ! 

end2 &  7#b7 9 section #bgjd7;f7 7#db   
,u4,s4,c4 #cjj;gg-#c7;f771 by add+ at ! 
end ! foll[+3  7#d7 ,public heal?       
em]g5cies ,if ! ,secret>y decl>es a     
public heal? em]g5cy "u section #cai1   
gr\p heal? plan1 & a gr\p heal?         
insurance issu] (f]+ gr\p heal?         
insurance cov]age 9 connection ) a gr\p 
heal? plan1 %all p]mit an employee :o is
 eligible1 b n enroll$1 = cov]age "u !  
t]ms ( ! plan or cov]age 7or a dep5d5t (
 su* an employee if ! dep5d5t is        
eligible1 b n enroll$1 = cov]age "u su* 
t]ms7 to enroll = cov]age "u ! t]ms ( ! 
plan or cov]age dur+ ! special enrollm5t
 p]iod requir$ "u section #bgjb7;b77#b7 
( ! ,public ,heal? ,s]vice ,act 7#db    
,u4,s4,c4 #cjj;gg-#a7;b77#b774  4  7b7  
,,erisa ,section #gja7;f7 ( ! ,employee 
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aaha7;f77 is am5d$
 by add+ at ! end ! foll[+3  7#d7       
,public heal? em]g5cies ,if ! ,secret>y 
( ,heal? & ,human ,s]vices decl>es a    
public heal? em]g5cy "u section #cai ( !

 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bdg;d71 a gr\p heal? plan1 or
 a heal? insurance issu] (f]+ gr\p heal?
 insurance cov]age 9 connection ) su* a 
plan1 %all p]mit an employee :o is      
eligible1 b n enroll$1 = cov]age "u !   
t]ms ( ! plan or cov]age 7or a dep5d5t (
 su* an employee if ! dep5d5t is        
eligible1 b n enroll$1 = cov]age "u su* 
t]ms7 to enroll = cov]age "u ! t]ms ( ! 
plan or cov]age dur+ ! special enrollm5t
 p]iod requir$ "u section #bgjb7;b77#b7 
( ! ,public ,heal? ,s]vice ,act 7#db    
,u4,s4,c4 #cjj;gg-#a7;b77#b774  4  7c7  
,,irc ,section #ihja7;f7 ( ! ,int]nal   
,rev5ue ,code ( #aihf 7#bf ,u4,s4,c4    
#ihja7;f77 is am5d$ by add+ at ! end !  
foll[+ new p>agraph3  7#d7 ,public heal?
 em]g5cies ,if ! ,secret>y ( ,heal? &   
,human ,s]vices decl>es a public heal?  
em]g5cy "u section #cai ( ! ,public     
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bdg;d71 a gr\p heal? plan %all p]mit an
 employee :o is eligible1 b n enroll$1 =
 cov]age "u ! t]ms ( ! plan 7or a       

dep5d5t ( su* an employee if ! dep5d5t  
is eligible1 b n enroll$1 = cov]age "u  
su* t]ms7 to enroll = cov]age "u ! t]ms 
( ! plan dur+ ! special enrollm5t p]iod 
requir$ "u section #bgjb7;b77#b7 ( !    
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#a7;b77#b774  4  7d7  
,rule ( con/ruction ,no?+ 9 ! am5dm5ts  
made by subsections 7a7 & 7b7 %all be   
con/ru$ to prev5t gr\p heal? plan or    
heal? insurance issu] f (f]+ a special  
enrollm5t p]iod 9 addition to any su*   
p]iod requir$ "u ,f$]al law4  #c4       
,cov]age ( prev5tion & treatm5t relat$  
to public heal? em]g5cies  7a7 ,requir$ 
cov]age  7#a7 ,9 g5]al ,subp>t ,,ii ( "p
 ,a ( title ,,xxvii ( ! ,public ,heal?  
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa 
et seq47 is am5d$ by add+ at ! end !    
foll[+3  #bgbi;,a4 ,cov]age ( prev5tion 
& treatm5t relat$ to public heal?       
em]g5cies  7a7 ,9 g5]al ,a gr\p heal?   
plan or a heal? insurance issu] (f]+    
gr\p or individual heal? insurance      
cov]age %all provide cov]age = su*      

s]vices relat$ to a disease or condition
 relat+ to a public heal? em]g5cy decl>$
 "u section #cai1 :i*1 z applicable1    
%all include any s]vices = ! prev5tion  
or treatm5t1 ( ! disease or condition4  
7b7 ,scope ( b5efits ,! prev5tion &     
treatm5t measures = :i* cov]age is      
requir$ "u subsection 7a7 %all-- 7#a7 be
 at ! same level z b5efits = ! prev5tion
 or treatm5t ( o!r simil> or relat$     
diseases or conditions1 if applicable1  
"u ! plan or cov]age2 &  7#b7 include1 )
 respect to ! disease or condition      
reasonably relat$ to ! public heal?     
em]g5cy1 ev5 if no diagnosis has be5    
made & ev5 if ! enrollee ultimately is  
det]m9$ n to h ! disease or condition1 z
 applicable-- 7,a7 vacc9es to prev5t !  
disease or condition1 if applicable2    
7,b7 te/+ = diagnosis ( ! disease or    
condition1 if applicable2  7,c7 c>e     
relat$ to symptoms an enrollee may      
exp]i5ce2 &  7,d7 treatm5ts = ! disease 
or condition4  7c7 ,co/-,%>+ ,co/-%>+ = 
s]vices = :i* cov]age is requir$ "u     

subsection 7a7 %all be comp>able to     
simil> su* s]vices t w\ld be cov]$ by ! 
plan or cov]age outside ( a public heal?
 em]g5cy4  7d7 ,waiv] ( re/rictions     
7#a7 ,9 g5]al ,a gr\p heal? plan or     
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age %all 
waive any re/riction 7includ+ any prior 
au?orization requirem5t1 limitation on  
fill+ or refill+ prescription drugs1 or 
o!r re/rictions7 on access to cov]$     
b5efits requir$ "u ?is section1 if !    
s]vice is det]m9$ by a qualifi$ heal?   
pr(essional to be m$ically necess>y by !
 provid] & ! ,secret>y det]m9es su*     
re/riction to be unduly burd5some 9 !   
context ( ! applicable public heal?     
em]g5cy4  7#b7 ,t]m ( waiv] ,any waiv] (
 re/rictions pursuant to p>agraph 7#a7  
%all apply only = ! duration ( ! public 
heal? em]g5cy1 z decl>$ "u section #cai4
  4  7#b7 ,,erisa  7,a7 ,9 g5]al ,subp>t
 ,b ( "p #g ( subtitle ,b ( title ,i ( !
 ,employee ,retirem5t ,income ,security 
,act ( #aigd 7#bi ,u4,s4,c4 #aaha et4   

seq47 is am5d$ by add+ at ! end !       
foll[+3  #gaf4 ,cov]age ( prev5tion &   
treatm5t relat$ to public heal?         
em]g5cies  7a7 ,9 g5]al ,a gr\p heal?   
plan or a heal? insurance issu] (f]+    
gr\p heal? insurance cov]age1 %all      
provide cov]age = su* s]vices relat$ to 
a disease or condition relat+ to a      
public heal? em]g5cy decl>$ "u section  
#cai ( ! ,public ,heal? ,s]vice ,act1   
:i*1 z applicable1 %all include any     
s]vices = ! prev5tion or treatm5t1 ( !  
disease or condition4  7b7 ,scope (     
b5efits ,! prev5tion & treatm5t measures
 = :i* cov]age is requir$ "u subsection 
7a7 %all-- 7#a7 be at ! same level z    
b5efits = ! prev5tion or treatm5t ( o!r 
simil> or relat$ diseases or conditions1
 if applicable1 "u ! plan or cov]age2 & 
7#b7 include1 ) respect to ! disease or 
condition reasonably relat$ to ! public 
heal? em]g5cy1 ev5 if no diagnosis has  
be5 made & ev5 if ! enrollee ultimately 
is det]m9$ n to h ! disease or          
condition1 z applicable-- 7,a7 vacc9es  

to prev5t ! disease or condition1 if    
applicable2  7,b7 te/+ = diagnosis ( !  
disease or condition1 if applicable2    
7,c7 c>e relat$ to symptoms an enrollee 
may exp]i5ce2 &  7,d7 treatm5ts = !     
disease or condition4  7c7 ,co/-,%>+    
,co/-%>+ = s]vices = :i* cov]age is     
requir$ "u subsection 7a7 %all be       
comp>able to simil> su* s]vices t w\ld  
be cov]$ by ! plan or cov]age outside ( 
a public heal? em]g5cy4  7d7 ,waiv] (   
re/rictions  7#a7 ,9 g5]al ,a gr\p heal?
 plan or heal? insurance issu] (f]+ gr\p
 heal? insurance cov]age %all waive any 
re/riction 7includ+ any prior           
au?orization requirem5t1 limitation on  
fill+ or refill+ prescription drugs1 or 
o!r re/rictions7 on access to cov]$     
b5efits requir$ "u ?is section1 if !    
s]vice is det]m9$ by a qualifi$ heal?   
pr(essional to be m$ically necess>y by !
 provid] & ! ,secret>y det]m9es su*     
re/riction to be unduly burd5some 9 !   
context ( ! applicable public heal?     
em]g5cy4  7#b7 ,t]m ( waiv] ,any waiv] (

 re/rictions pursuant to p>agraph 7#a7  
%all apply only = ! duration ( ! public 
heal? em]g5cy1 z decl>$ "u section #cai 
( ! ,public ,heal? ,s]vice ,act4  4     
7,b7 ,cl]ical am5dm5t ,! table (        
sections = subp>t ,b ( "p #g ( subtitle 
,b ( title ,i ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd is am5d$ 
by add+ at ! end ! foll[+3  ,sec4 #gae4 
,additional m>ket re=ms4,sec4 #gaf4     
,cov]age ( prev5tion & treatm5t relat$  
to public heal? em]g5cies4  4  7#c7     
,,irc  7,a7 ,9 g5]al ,sub*apt] ,b (     
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end ! foll[+
 new section3  #ihaf4 ,cov]age (        
prev5tion & treatm5t relat$ to public   
heal? em]g5cies  7a7 ,9 g5]al ,a gr\p   
heal? plan %all provide cov]age = su*   
s]vices relat$ to a disease or condition
 relat+ to a public heal? em]g5cy decl>$
 "u section #cai ( ! ,public ,heal?     
,s]vice ,act1 :i*1 z applicable1 %all   
include any s]vices = ! prev5tion or    
treatm5t1 ( ! disease or condition4  7b7

 ,scope ( b5efits ,! prev5tion &        
treatm5t measures = :i* cov]age is      
requir$ "u subsection 7a7 %all-- 7#a7 be
 at ! same level z b5efits = ! prev5tion
 or treatm5t ( o!r simil> or relat$     
diseases or conditions1 if applicable1  
"u ! plan2 &  7#b7 include1 ) respect to
 ! disease or condition reasonably      
relat$ to ! public heal? em]g5cy1 ev5 if
 no diagnosis has be5 made & ev5 if !   
enrollee ultimately is det]m9$ n to h ! 
disease or condition1 z applicable--    
7,a7 vacc9es to prev5t ! disease or     
condition1 if applicable2  7,b7 te/+ =  
diagnosis ( ! disease or condition1 if  
applicable2  7,c7 c>e relat$ to symptoms
 an enrollee may exp]i5ce2 &  7,d7      
treatm5ts = ! disease or condition4  7c7
 ,co/-,%>+ ,co/-%>+ = s]vices = :i*     
cov]age is requir$ "u subsection 7a7    
%all be comp>able to simil> su* s]vices 
t w\ld be cov]$ by ! plan outside ( a   
public heal? em]g5cy4  7d7 ,waiv] (     
re/rictions  7#a7 ,9 g5]al ,a gr\p heal?
 plan %all waive any re/riction 7includ+

 any prior au?orization requirem5t1     
limitation on fill+ or refill+          
prescription drugs1 or o!r re/rictions7 
on access to cov]$ b5efits requir$ "u   
?is section1 if ! s]vice is det]m9$ by a
 qualifi$ heal? pr(essional to be       
m$ically necess>y by ! provid] & !      
,secret>y det]m9es su* re/riction to be 
unduly burd5some 9 ! context ( !        
applicable public heal? em]g5cy4  7#b7  
,t]m ( waiv] ,any waiv] ( re/rictions   
pursuant to p>agraph 7#a7 %all apply    
only = ! duration ( ! public heal?      
em]g5cy1 z decl>$ "u section #cai ( !   
,public ,heal? ,s]vice ,act4  4  7,b7   
,cl]ical am5dm5t ,! table ( sections =  
sub*apt] ,b ( *apt] #ajj ( su* ,code is 
am5d$ by add+ at ! end ! foll[+ new     
item3  ,sec4 #ihaf4 ,cov]age ( prev5tion
 & treatm5t relat$ to public heal?      
em]g5cies4  4  #d4 ,effective date2     
application ,! am5dm5ts made by ?is ,act
 %all take effect on ! date ( enactm5t (
 ?is ,act & %all apply ) respect to     
plans ye>s 9 effect on ! date ( enactm5t

 ( ?is ,act1 & plan ye>s beg9n+ on or   
aft] su* date4