,,ii ,cal5d> ,no4 #eed #aaf? ,,congress 
#b;d ,session  ,s4 #dfge  ,,9 ,,!       
,,s5ate ,,( ,,! ,,unit$ ,,/ates         
,septemb] #bc1 #bjbj,mr4 ,tillis        
introduc$ ! foll[+ bill2 :i* 0 read !   
fir/ "t  ,septemb] #bd1 #bjbj,read !    
second "t & plac$ on ! cal5d>  ,a ,,bill
  ,to am5d ! ,heal? ,insurance          
,portability & ,acc\ntability ,act4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,protect ,act4  #b4 ,f9d+s ,congress    
f9ds z foll[s3 7#a7 ,9 ,presid5t        
,obama's la/ ye> 9 (fice1 ,obamac>e's   
high co/s expos$ work+ ,am]icans to     
pot5tial heal? insurance cov]age loss1 !
 mo/ extreme =m ( lack+ pre-exi/+       
conditions protection4 ,t ye>1 !re 0 a  
#bj p]c5t decrease 9 enrollm5t 9 plans  
(f]$ on ! ,ex*ange among work+ ,am]icans
 :o e>n$ too mu* to receive a premium   
tax cr$it subsidy1 b n en\gh to cov] !  
ov] #aje p]c5t increases 9 premiums "u  
,obamac>e4  7#b7 ,9 #bjae1 ne>ly #hj    
p]c5t ( ! h\seholds :o paid ! individual
 m&ate tax e>n$ less ?an #ej1jjj p] ye>4

  7#c7 ,recogniz+ ?is unfair burd51 9   
,decemb] #bjag1 ,congress act$ to re/ore
 fre$om & lib]ty to ,am]icans by        
elim9at+ ! p5alty = noncompliance ) su* 
individual m&ate4  7#d7 ,obamac>e is n !
 only way to protect ,am]icans )        
pre-exi/+ conditions4  7#e7 ,obamac>e's 
"o-size-fits-all approa* und]m9es       
,/ates' ability to c>e = _! populations 
& left _m ,am]icans unable to af=d any  
heal? insurance 9 ! individual m>ket4   
7#f7 ,congress w protect individuals )  
preexi/+ conditions if ! ,supreme ,c\rt 
ultimately det]m9es 9 ,texas v4         
,cali=nia t ,obamac>e is                
uncon/itutional4  #c4 ,gu>ante$         
availability ( cov]age2 prohibit+       
discrim9ation  7a7 ,9 g5]al ,subtitle ,c
 ( title ,i ( ! ,heal? ,insurance       
,portability & ,acc\ntability ,act (    
#aiif 7,public ,law #ajd-aia7 is am5d$  
by add+ at ! end ! foll[+3  #aif4       
,prohibition ( pre-exi/+ condition      
exclusions  7a7 ,9 g5]al ,a gr\p heal?  
plan & a heal? insurance issu] (f]+ gr\p

 or individual heal? insurance cov]age  
may n impose any pre-exi/+ condition    
exclusion ) respect to su* plan or      
cov]age4  7b7 ,def9itions ,= purposes ( 
?is section3 7#a7 ,pre-exi/+ condition  
exclusion  7,a7 ,9 g5]al ,! t]m         
pre-exi/+ condition exclusion means1 )  
respect to cov]age1 a limitation or     
exclusion ( b5efits relat+ to a         
condition bas$ on ! fact t ! condition 0
 pres5t be=e ! enrollm5t date = su*     
cov]age1 :e!r or n any m$ical advice1   
diagnosis1 c>e1 or treatm5t 0 recomm5d$ 
or receiv$ be=e su* date4  7,b7         
,treatm5t ( g5etic in=mation ,g5etic    
in=mation %all n be treat$ z a condition
 describ$ 9 subp>agraph 7,a7 9 ! abs5ce 
( a diagnosis ( ! condition relat$ to   
su* in=mation4  7#b7 ,enrollm5t date ,! 
t]m enrollm5t date means1 ) respect to  
an individual cov]$ "u a gr\p heal? plan
 or heal? insurance cov]age1 ! date (   
enrollm5t ( ! individual 9 ! plan or    
cov]age or1 if e>li]1 ! fir/ day ( !    
wait+ p]iod = su* enrollm5t4  7#c7      

,wait+ p]iod ,! t]m wait+ p]iod means1 )
 respect to a gr\p heal? plan & an      
individual :o is a pot5tial p>ticipant  
or b5efici>y 9 ! plan1 ! p]iod t mu/    
pass ) respect to ! individual be=e !   
individual is eligible to be cov]$ =    
b5efits "u ! t]ms ( ! plan4  #aig4      
,gu>ante$ availability ( cov]age  7a7   
,gu>ante$ issuance ( cov]age 9 !        
individual & gr\p m>ket ,subject to     
subsections 7b7 ?r\gh 7d71 ea* heal?    
insurance issu] t (f]s heal? insurance  
cov]age 9 ! individual or gr\p m>ket 9 a
 ,/ate mu/ accept e employ] & individual
 9 ! ,/ate t applies = su* cov]age4  7b7
 ,enrollm5t  7#a7 ,re/riction ,a heal?  
insurance issu] describ$ 9 subsection   
7a7 may re/rict enrollm5t 9 cov]age     
describ$ 9 su* subsection to op5 or     
special enrollm5t p]iods4  7#b7         
,e/abli%m5t ,a heal? insurance issu]    
describ$ 9 subsection 7a7 %all1 9       
accordance ) ! regulations promulgat$ "u
 p>agraph 7#c71 e/abli% special         
enrollm5t p]iods = qualify+ ev5ts 7"u   

section #fjc ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd74  7#c7  
,regulations ,! ,secret>y %all          
promulgate regulations ) respect to     
enrollm5t p]iods "u p>agraphs 7#a7 &    
7#b74  7c7 ,special rules = network     
plans  7#a7 ,9 g5]al ,9 ! case ( a heal?
 insurance issu] t (f]s heal? insurance 
cov]age 9 ! gr\p & individual m>ket     
?r\gh a network plan1 ! issu] may-- 7,a7
 limit ! employ]s t may apply = su*     
cov]age to ^? ) eligible individuals :o 
live1 "w1 or reside 9 ! s]vice area =   
su* network plan2 &  7,b7 )9 ! s]vice   
area ( su* plan1 d5y su* cov]age to su* 
employ]s & individuals if ! issu] has   
demon/rat$1 if requir$1 to ! applicable 
,/ate au?ority t-- 7i7 x w n h !        
capacity to deliv] s]vices adequately to
 enrollees ( any additional gr\ps or any
 additional individuals because ( its   
obligations to exi/+ gr\p contract      
hold]s & enrollees2 &  7ii7 x is apply+ 
?is p>agraph uni=mly to all employ]s &  
individuals )\t reg>d to ! claims       

exp]i5ce ( ^? individuals1 employ]s & _!
 employees 7& _! dep5d5ts71 or any heal?
 /atus-relat$ factor relat+ to su*      
individuals1 employees1 & dep5d5ts4     
7#b7 #ahj-;day susp5sion ^u d5ial (     
cov]age ,an issu]1 ^u d5y+ heal?        
insurance cov]age 9 any s]vice area 9   
accordance ) p>agraph 7#a77;,b71 may n  
(f] cov]age 9 ! gr\p or individual m>ket
 )9 su* s]vice area = a p]iod ( #ahj    
days aft] ! date su* cov]age is d5i$4   
7d7 ,application ( f9ancial capacity    
limits  7#a7 ,9 g5]al ,a heal? insurance
 issu] may d5y heal? insurance cov]age 9
 ! gr\p or individual m>ket if ! issu]  
has demon/rat$1 if requir$1 to !        
applicable ,/ate au?ority t-- 7,a7 x    
does n h ! f9ancial res]ves necess>y to 
und]write additional cov]age2 &  7,b7 x 
is apply+ ?is p>agraph uni=mly to all   
employ]s & individuals 9 ! gr\p or      
individual m>ket 9 ! ,/ate consi/5t )   
applicable ,/ate law & )\t reg>d to !   
claims exp]i5ce ( ^? individuals1       
employ]s & _! employees 7& _! dep5d5ts7 

or any heal? /atus-relat$ factor relat+ 
to su* individuals1 employees1 &        
dep5d5ts4  7#b7 #ahj-;day susp5sion ^u  
d5ial ( cov]age ,a heal? insurance issu]
 ^u d5y+ heal? insurance cov]age 9      
connection ) gr\p heal? plans 9         
accordance ) p>agraph 7#a7 9 a ,/ate may
 n (f] cov]age 9 connection ) gr\p heal?
 plans 9 ! gr\p or individual m>ket 9 ! 
,/ate = a p]iod ( #ahj days aft] ! date 
su* cov]age is d5i$ or until ! issu] has
 demon/rat$ to ! applicable ,/ate       
au?ority1 if requir$ "u applicable ,/ate
 law1 t ! issu] has suffici5t f9ancial  
res]ves to und]write additional cov]age1
 :i*ev] is lat]4 ,an applicable ,/ate   
au?ority may provide = ! application (  
?is subsection on a s]vice-area-specific
 basis  7e7 ,def9itions ,9 ?is section &
 9 sections #aif & #aih3 7#a7 ,! t]m    
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  7#b7 ,! t]ms g5etic   
in=mation1 g5etic te/1 gr\p heal? plan1 
gr\p m>ket1 heal? insurance cov]age1    
heal? insurance issu]1 gr\p heal?       

insurance cov]age1 individual heal?     
insurance cov]age1 individual m>ket1 &  
und]writ+ purpose h ! mean+s giv5 su*   
t]ms 9 section #bgia ( ! ,public ,heal? 
,s]vice ,act4  4  #aih4 ,prohibit+      
discrim9ation aga9/ individual          
p>ticipants & b5efici>ies bas$ on heal? 
/atus  7a7 ,9 g5]al ,a gr\p heal? plan &
 a heal? insurance issu] (f]+ gr\p or   
individual heal? insurance cov]age may n
 e/abli% rules = eligibility 7includ+   
cont9u$ eligibility7 ( any individual to
 enroll "u ! t]ms ( ! plan or cov]age   
bas$ on any ( ! foll[+ heal?            
/atus-relat$ factors 9 relation to !    
individual or a dep5d5t ( ! individual3 
7#a7 ,heal? /atus4  7#b7 ,m$ical        
condition 7includ+ bo? physical & m5tal 
illnesses74  7#c7 ,claims exp]i5ce4     
7#d7 ,receipt ( heal? c>e4  7#e7 ,m$ical
 hi/ory4  7#f7 ,g5etic in=mation4  7#g7 
,evid5ce ( insurability 7includ+        
conditions aris+ out ( acts ( dome/ic   
viol5ce74  7#h7 ,disability4  7#i7 ,any 
o!r heal? /atus-relat$ factor det]m9$   

appropriate by ! ,secret>y4  7b7 ,9     
premium contributions  7#a7 ,9 g5]al ,a 
gr\p heal? plan1 & a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age1 may n require any    
individual 7z a condition ( enrollm5t or
 cont9u$ enrollm5t "u ! plan7 to pay a  
premium or contribution :i* is great]   
?an su* premium or contribution = a     
simil>ly situat$ individual enroll$ 9 ! 
plan on ! basis ( any heal? /atus-relat$
 factor 9 relation to ! individual or to
 an individual enroll$ "u ! plan z a    
dep5d5t ( ! individual4  7#b7           
,con/ruction ,no?+ 9 p>agraph 7#a7 %all 
be con/ru$-- 7,a7 to re/rict ! am\nt t  
an employ] or individual may be *>g$ =  
cov]age "u a gr\p heal? plan except z   
provid$ 9 p>agraph 7#c7 or individual   
heal? cov]age1 z ! case may be2 or  7,b7
 to prev5t a gr\p heal? plan1 & a heal? 
insurance issu] (f]+ gr\p heal?         
insurance cov]age1 f e/abli%+ premium   
disc\nts or rebates or modify+ o!rwise  
applicable copaym5ts or d$uctibles 9    

return = adh]5ce to programs ( heal?    
promotion & disease prev5tion4  7#c7 ,no
 gr\p-bas$ discrim9ation on basis (     
g5etic in=mation  7,a7 ,9 g5]al ,=      
purposes ( ?is section1 a gr\p heal?    
plan1 & heal? insurance issu] (f]+ gr\p 
heal? insurance cov]age 9 connection ) a
 gr\p heal? plan1 may n adju/ premium or
 contribution am\nts = ! gr\p cov]$ "u  
su* plan on ! basis ( g5etic in=mation4 
7,b7 ,rule ( con/ruction ,no?+ 9        
subp>agraph 7,a7 or 9 p>agraphs 7#a7 &  
7#b7 ( subsection 7d7 %all be con/ru$ to
 limit ! ability ( a heal? insurance    
issu] (f]+ gr\p or individual heal?     
insurance cov]age to increase ! premium 
= an employ] bas$ on ! manife/ation ( a 
disease or disord] ( an individual :o is
 enroll$ 9 ! plan4 ,9 su* case1 !       
manife/ation ( a disease or disord] 9 "o
 individual _c also be us$ z g5etic     
in=mation ab\t o!r gr\p memb]s & to     
fur!r increase ! premium = ! employ]4   
7c7 ,g5etic te/+  7#a7 ,limitation on   
reque/+ or requir+ g5etic te/+ ,a gr\p  

heal? plan1 & a heal? insurance issu]   
(f]+ heal? insurance cov]age 9          
connection ) a gr\p heal? plan1 %all n  
reque/ or require an individual or a    
family memb] ( su* individual to und]go 
a g5etic te/4  7#b7 ,rule ( con/ruction 
,p>agraph 7#a7 %all n be con/ru$ to     
limit ! au?ority ( a heal? c>e          
pr(essional :o is provid+ heal? c>e     
s]vices to an individual to reque/ t su*
 individual und]go a g5etic te/4  7#c7  
,rule ( con/ruction reg>d+ paym5t  7,a7 
,9 g5]al ,no?+ 9 p>agraph 7#a7 %all be  
con/ru$ to preclude a gr\p heal? plan1  
or a heal? insurance issu] (f]+ heal?   
insurance cov]age 9 connection ) a gr\p 
heal? plan1 f obta9+ & us+ ! results ( a
 g5etic te/ 9 mak+ a det]m9ation reg>d+ 
paym5t 7z su* t]m is def9$ = ! purposes 
( apply+ ! regulations promulgat$ by !  
,secret>y "u "p ,c ( title ,,xi ( !     
,social ,security ,act & section #bfd ( 
?is ,act1 z may be revis$ f "t to "t7   
consi/5t ) subsection 7a74  7,b7        
,limitation ,= purposes ( subp>agraph   

7,a71 a gr\p heal? plan1 or a heal?     
insurance issu] (f]+ heal? insurance    
cov]age 9 connection ) a gr\p heal?     
plan1 may reque/ only ! m9imum am\nt (  
in=mation necess>y to accompli% ! int5d$
 purpose4  7#d7 ,rese>* exception       
,not)/&+ p>agraph 7#a71 a gr\p heal?    
plan1 or a heal? insurance issu] (f]+   
heal? insurance cov]age 9 connection ) a
 gr\p heal? plan1 may reque/1 b n       
require1 t a p>ticipant or b5efici>y    
und]go a g5etic te/ if ea* ( ! foll[+   
conditions is met3 7,a7 ,! reque/ is    
made pursuant to rese>* t complies ) "p 
#df ( title #de1 ,code ( ,f$]al         
,regulations1 or equival5t ,f$]al       
regulations1 & any applicable ,/ate or  
local law or regulations = ! protection 
( human subjects 9 rese>*4  7,b7 ,! plan
 or issu] cle>ly indicates to ea*       
p>ticipant or b5efici>y1 or 9 ! case ( a
 m9or *ild1 to ! legal gu>dian ( su*    
b5efici>y1 to :om ! reque/ is made t--  
7i7 compliance ) ! reque/ is volunt>y2 &
  7ii7 noncompliance w h no effect on   

enrollm5t /atus or premium or           
contribution am\nts4  7,c7 ,no g5etic   
in=mation collect$ or acquir$ "u ?is    
p>agraph %all be us$ = und]writ+        
purposes4  7,d7 ,! plan or issu]        
notifies ! ,secret>y 9 writ+ t ! plan or
 issu] is conduct+ activities pursuant  
to ! exception provid$ = "u ?is         
p>agraph1 includ+ a description ( !     
activities conduct$4  7,e7 ,! plan or   
issu] complies ) su* o!r conditions z ! 
,secret>y may by regulation require =   
activities conduct$ "u ?is p>agraph4    
7d7 ,prohibition on collection ( g5etic 
in=mation  7#a7 ,9 g5]al ,a gr\p heal?  
plan1 & a heal? insurance issu] (f]+    
heal? insurance cov]age 9 connection ) a
 gr\p heal? plan1 %all n reque/1        
require1 or pur*ase g5etic in=mation =  
und]writ+ purposes4  7#b7 ,prohibition  
on collection ( g5etic in=mation prior  
to enrollm5t ,a gr\p heal? plan1 & a    
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 connection ) a gr\p 
heal? plan1 %all n reque/1 require1 or  

pur*ase g5etic in=mation ) respect to   
any individual prior to su* individual's
 enrollm5t "u ! plan or cov]age 9       
connection ) su* enrollm5t4  7#c7       
,incid5tal collection ,if a gr\p heal?  
plan1 or a heal? insurance issu] (f]+   
heal? insurance cov]age 9 connection ) a
 gr\p heal? plan1 obta9s g5etic         
in=mation incid5tal to ! reque/+1       
requir+1 or pur*as+ ( o!r in=mation     
conc]n+ any individual1 su* reque/1     
requirem5t1 or pur*ase %all n be        
consid]$ a violation ( p>agraph 7#b7 if 
su* reque/1 requirem5t1 or pur*ase is n 
9 violation ( p>agraph 7#a74  7e7       
,g5etic in=mation ( a fetus or embryo   
,any ref]5ce 9 ?is "p to g5etic         
in=mation conc]n+ an individual or      
family memb] ( an individual %all-- 7#a7
 ) respect to su* an individual or      
family memb] ( an individual :o is a    
pregnant woman1 include g5etic in=mation
 ( any fetus c>ri$ by su* pregnant      
woman2 &  7#b7 ) respect to an          
individual or family memb] utiliz+ an   

assi/$ reproductive te*nology1 include  
g5etic in=mation ( any embryo legally   
held by ! individual or family memb]4   
7f7 ,programs ( heal? promotion or      
disease prev5tion  7#a7 ,g5]al          
provisions  7,a7 ,g5]al rule ,= purposes
 ( subsection 7b77#b77;,b71 a program ( 
heal? promotion or disease prev5tion    
7ref]r$ to 9 ?is subsection z a wellness
 program7 %all be a program (f]$ by an  
employ] t is design$ to promote heal? or
 prev5t disease t meets ! applicable    
requirem5ts ( ?is subsection4  7,b7 ,no 
conditions bas$ on heal? /atus factor   
,if none ( ! conditions = obta9+ a      
premium disc\nt or rebate or o!r rew>d =
 p>ticipation 9 a wellness program is   
bas$ on an individual satisfy+ a /&>d t 
is relat$ to a heal? /atus factor1 su*  
wellness program %all n violate ?is     
section if p>ticipation 9 ! program is  
made available to all simil>ly situat$  
individuals & ! requirem5ts ( p>agraph  
7#b7 are compli$ )4  7,c7 ,conditions   
bas$ on heal? /atus factor ,if any ( !  

conditions = obta9+ a premium disc\nt or
 rebate or o!r rew>d = p>ticipation 9 a 
wellness program is bas$ on an          
individual satisfy+ a /&>d t is relat$  
to a heal? /atus factor1 su* wellness   
program %all n violate ?is section if ! 
requirem5ts ( p>agraph 7#c7 are compli$ 
)4  7#b7 ,wellness programs n subject to
 requirem5ts ,if none ( ! conditions =  
obta9+ a premium disc\nt or rebate or   
o!r rew>d "u a wellness program z       
describ$ 9 p>agraph 7#a77;,b7 are bas$  
on an individual satisfy+ a /&>d t is   
relat$ to a heal? /atus factor 7or if   
su* a wellness program does n provide   
su* a rew>d71 ! wellness program %all n 
violate ?is section if p>ticipation 9 ! 
program is made available to all        
simil>ly situat$ individuals4 ,! foll[+ 
programs %all n h to comply ) !         
requirem5ts ( p>agraph 7#c7 if          
p>ticipation 9 ! program is made        
available to all simil>ly situat$       
individuals3 7,a7 ,a program t          
reimburses all or "p ( ! co/ = memb]%ips

 9 a fitness c5t]4  7,b7 ,a diagno/ic   
te/+ program t provides a rew>d =       
p>ticipation & does n base any "p ( !   
rew>d on outcomes4  7,c7 ,a program t   
enc\rages prev5tive c>e relat$ to a     
heal? condition ?r\gh ! waiv] ( !       
copaym5t or d$uctible requirem5t "u gr\p
 heal? plan = ! co/s ( c]ta9 items or   
s]vices relat$ to a heal? condition 7su*
 z pr5atal c>e or well-baby visits74    
7,d7 ,a program t reimburses individuals
 = ! co/s ( smok+ cessation programs )\t
 reg>d to :e!r ! individual quits smok+4
  7,e7 ,a program t provides a rew>d to 
individuals = att5d+ a p]iodic heal?    
education sem9>4  7#c7 ,wellness        
programs subject to requirem5ts ,if any 
( ! conditions = obta9+ a premium       
disc\nt1 rebate1 or rew>d "u a wellness 
program z describ$ 9 p>agraph 7#a77;,c7 
is bas$ on an individual satisfy+ a /&>d
 t is relat$ to a heal? /atus factor1 ! 
wellness program %all n violate ?is     
section if ! foll[+ requirem5ts are     
compli$ )3 7,a7 ,! rew>d = ! wellness   

program1 toge!r ) ! rew>d = o!r wellness
 programs ) respect to ! plan t requires
 satisfaction ( a /&>d relat$ to a heal?
 /atus factor1 %all n exce$ #cj p]c5t ( 
! co/ ( employee-only cov]age "u ! plan4
 ,if1 9 addition to employees or        
individuals1 any class ( dep5d5ts 7su* z
 sp\ses or sp\ses & dep5d5t *ildr57 may 
p>ticipate fully 9 ! wellness program1  
su* rew>d %all n exce$ #cj p]c5t ( ! co/
 ( ! cov]age 9 :i* an employee or       
individual & any dep5d5ts are enroll$4  
,= purposes ( ?is p>agraph1 ! co/ (     
cov]age %all be det]m9$ bas$ on ! total 
am\nt ( employ] & employee contributions
 = ! b5efit package "u :i* ! employee is
 7or ! employee & any dep5d5ts are7     
receiv+ cov]age4 ,a rew>d may be 9 ! =m 
( a disc\nt or rebate ( a premium or    
contribution1 a waiv] ( all or "p ( a   
co/-%>+ me*anism 7su* z d$uctibles1     
copaym5ts1 or co9surance71 ! abs5ce ( a 
sur*>ge1 or ! value ( a b5efit t w\ld   
o!rwise n be provid$ "u ! plan4 ,!      
,secret>ies ( ,labor1 ,heal? & ,human   

,s]vices1 & ! ,treasury may increase !  
rew>d available "u ?is subp>agraph to up
 to #ej p]c5t ( ! co/ ( cov]age if !    
,secret>ies det]m9e t su* an increase is
 appropriate4  7,b7 ,! wellness program 
%all be reasonably design$ to promote   
heal? or prev5t disease4 ,a program     
complies ) ! prec$+ s5t5ce if ! program 
has a reasonable *ance ( improv+ ! heal?
 (1 or prev5t+ disease 91 p>ticipat+    
individuals & x is n ov]ly burd5some1 is
 n a subt]fuge = discrim9at+ bas$ on a  
heal? /atus factor1 & is n highly       
suspect 9 ! me?od *os5 to promote heal? 
or prev5t disease4  7,c7 ,! plan %all   
give individuals eligible = ! program ! 
opportunity to qualify = ! rew>d "u !   
program at lea/ once ea* ye>4  7,d7 ,!  
full rew>d "u ! wellness program %all be
 made available to all simil>ly situat$ 
individuals4 ,= su* purpose1 among o!r  
?+s3 7i7 ,! rew>d is n available to all 
simil>ly situat$ individuals = a p]iod  
unless ! wellness program all[s-- 7,i7 =
 a reasonable alt]native /&>d 7or waiv] 

( ! o!rwise applicable /&>d7 = obta9+ ! 
rew>d = any individual = :om1 = t p]iod1
 x is unreasonably difficult due to a   
m$ical condition to satisfy ! o!rwise   
applicable /&>d2 &  7,,ii7 = a          
reasonable alt]native /&>d 7or waiv] ( !
 o!rwise applicable /&>d7 = obta9+ !    
rew>d = any individual = :om1 = t p]iod1
 x is m$ically inadvisable to attempt to
 satisfy ! o!rwise applicable /&>d4     
7ii7 ,if reasonable "u ! circum/ances1 !
 plan or issu] may seek v]ification1 su*
 z a /atem5t f an individual's          
physician1 t a heal? /atus factor makes 
x unreasonably difficult or m$ically    
inadvisable = ! individual to satisfy or
 attempt to satisfy ! o!rwise applicable
 /&>d4  7,e7 ,! plan or issu] involv$   
%all disclose 9 all plan mat]ials       
describ+ ! t]ms ( ! wellness program !  
availability ( a reasonable alt]native  
/&>d 7or ! possibility ( waiv] ( !      
o!rwise applicable /&>d7 requir$ "u     
subp>agraph 7,d74 ,if plan mat]ials     
disclose t su* a program is available1  

)\t describ+ its t]ms1 ! disclosure "u  
?is subp>agraph %all n be requir$4  4   
7b7 ,con=m+ am5dm5t ,! table ( cont5ts  
"u section #a7;b7 ( ! ,heal? ,insurance 
,portability & ,acc\ntability ,act (    
#aiif 7,public ,law #ajd-aia7 is am5d$  
by ins]t+ aft] ! item relat+ to section 
#aie ! foll[+3  ,sec4 #aif4 ,prohibition
 ( pre-exi/+ condition exclusions4,sec4 
#aig4 ,gu>ante$ ,availability (         
,cov]age4,sec4 #aih4 ,prohibit+         
,discrim9ation aga9/ individual         
p>ticipants & b5efici>ies bas$ on heal? 
/atus4  4  7c7 ,en=cem5t  7#a7 ,,phsa   
,section #bgbc ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#bb7
 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 
9 p>agraph 7#a71 by ins]t+ & sections   
#aif 1#aig1 & #aih ( ! ,heal? ,insurance
 ,portability & ,acc\ntability ,act (   
#aiif aft] ?is "p2 &  7ii7 9 p>agraph   
7#b71 by ins]t+ or section #aif1 #aig1  
or #aih ( ! ,heal? ,insurance           
,portability & ,acc\ntability ,act (    
#aiif aft] ?is "p2 &  7,b7 9 subsection 

7b71 by ins]t+ or section #aif1 #aig1 or
 #aih ( ! ,heal? ,insurance ,portability
 & ,acc\ntability ,act ( #aiif aft] ?is 
"p ea* place su* t]m appe>s4  7#b7      
,,erisa ,section #gae ( ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aahe;d7 is am5d$  
by add+ at ! end ! foll[+3  7c7         
,additional provisions ,section #aig ( !
 ,heal? ,insurance ,portability &       
,acc\ntability ,act ( #aiif %all apply  
to heal? insurance issu]s provid+ heal? 
insurance cov]age 9 connection ) gr\p   
heal? plans1 & sections #aif & #aih (   
su* ,act %all apply to gr\p heal? plans 
& heal? insurance issu]s provid+ heal?  
insurance cov]age 9 connection ) gr\p   
heal? plans1 z if includ$ 9 ?is subp>t1 
& to ! ext5t t any provision ( ?is "p   
conflicts ) a provision ( su* section   
#aig ) respect to heal? insurance issu]s
 provid+ heal? insurance cov]age 9      
connection ) gr\p heal? plans or ( su*  
section #aif or #aih ) respect to gr\p  
heal? plans or heal? insurance issu]s   

provid+ heal? insurance cov]age 9       
connection ) gr\p heal? plans1 !        
provisions ( su* sections #aif1 #aig1 & 
#aih1 z applicable1 %all apply4  4  7#c7
 ,,irc ,section #ihae ( ! ,int]nal      
,rev5ue ,code ( #aihf is am5d$ by add+  
at ! end ! foll[+3  7c7 ,additional     
provisions ,section #aig ( ! ,heal?     
,insurance ,portability & ,acc\ntability
 ,act ( #aiif %all apply to heal?       
insurance issu]s provid+ heal? insurance
 cov]age 9 connection ) gr\p heal?      
plans1 & section #aif & #aih ( su* ,act 
%all apply to gr\p heal? plans & heal?  
insurance issu]s provid+ heal? insurance
 cov]age 9 connection ) gr\p heal?      
plans1 z if includ$ 9 ?is sub*apt]1 & to
 ! ext5t t any provision ( ?is *apt]    
conflicts ) a provision ( su* section   
#aig ) respect to heal? insurance issu]s
 provid+ heal? insurance cov]age 9      
connection ) gr\p heal? plans or ( su*  
section #aif or #aih ) respect to gr\p  
heal? plans or heal? insurance issu]s   
provid+ heal? insurance cov]age 9       

connection ) gr\p heal? plans1 !        
provisions ( su* sections #aif1 #aig1 & 
#aih1 z applicable1 %all apply4  4  7d7 
,effective date ,?is am5dm5ts made by   
?is section %all take effect "o day aft]
 ! date ( enactm5t ( ?is ,act4          
,septemb] #bd1 #bjbj,read ! second "t & 
plac$ on ! cal5d>