,i  #aag? ,,congress  #a/ ,session  ,h4 
,r4 #dfdj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bb1 #bjba,mr4  
,doggett 7= himself1 ,mr4 ,blum5au]1    
,mr4 ,c>twright1 ,ms4 ,*u1 ,mr4 ,cleav]1
 ,mr4 ,coh51 ,mr4 ,de,fazio1 ,mrs4      
,d+ell1 ,mr4 ,evans1 ,mr4 ,grijalva1    
,mrs4 ,hayes1 ,ms4 ,johnson ( ,texas1   
,ms4 ,kaptur1 ,mr4 ,khanna1 ,ms4 ,lee ( 
,cali=nia1 ,mr4 ,lev9 ( ,mi*igan1 ,mr4  
,l[5?al1 ,mrs4 ,c>olyn ,b4 ,maloney (   
,new ,york1 ,mr4 ,mfume1 ,mr4 ,nadl]1   
,ms4 ,norton1 ,mr4 ,p]lmutt]1 ,ms4      
,port]1 ,ms4 ,s*ak[sky1 ,ms4 ,sewell1   
,ms4 ,spei]1 ,mr4 ,suozzi1 ,mr4 ,takano1
 ,ms4 ,titus1 ,mr4 ,?ompson ( ,cali=nia1
 ,mr4 ,tonko1 ,ms4 ,de,lauro1 & ,mrs4   
,watson ,coleman7 introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,ways & ,means1 & 9 addition to !       
,committee on ,en]gy & ,comm]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 am5d 

title ,,xviii ( ! ,social ,security ,act
 to provide = c]ta9 re=ms ) respect to  
m$ic>e supplem5tal heal? insurance      
policies4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,close ! ,m$igap ,act (    
#bjba4  #b4 ,gu>ante$ issue  7a7 ,9     
g5]al ,section #ahhb7s7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciess7s77 is am5d$ to read z foll[s3  
7s7 7#a7 ,subject to p>agraph 7#b71 !   
issu] ( a m$ic>e supplem5tal policy may 
n1 9 ! case ( an individual entitl$ to  
b5efits "u "p ,a & enroll$ "u "p ,b--   
7,a7 d5y or condition ! issuance or     
effectiv5ess ( a m$ic>e supplem5tal     
policy1 or discrim9ate 9 ! pric+ ( !    
policy1 because ( heal? /atus1 claims   
exp]i5ce1 receipt ( heal? c>e1 or m$ical
 condition2  7,b7 exclude b5efits bas$  
on a preexi/+ condition2  7,c7 provide  
any "t p]iod applicable to preexi/+     
conditions1 wait+ p]iods1 elim9ation    
p]iods1 & probation>y p]iods = any      
b5efit2  7,d7 d5y or condition !        
issuance or effectiv5ess ( ! policy     

7includ+ ! imposition ( any exclusion ( 
b5efits "u ! policy bas$ on a preexi/+  
condition7 or discrim9ate 9 ! pric+ ( ! 
policy 7includ+ ! adju/m5t ( premium    
rates7 ( an individual on ! basis ( !   
g5etic in=mation ) respect to su*       
individual2  7,e7 d5y or condition !    
issuance or effectiv5ess ( a m$ic>e     
supplem5tal policy t is (f]$ & is       
available = issuance to new enrollees by
 su* issu]2 or  7,f7 e/abli% any p]iod  
limit+ enrollm5t "u a m$ic>e supplem5tal
 policy to su* p]iod = any individual4  
7#b7 ,p>agraph 7#a7 %all n apply to an  
individual entitl$ to b5efits "u "p ,a  
solely by reason ( section #bbf;,a4     
7#c7 ,no?+ 9 ?is subsection or 9        
subp>agraphs 7,a7 or 7,b7 ( subsection  
7x77#b7 %all be con/ru$ to limit !      
ability ( an issu] ( a m$ic>e           
supplem5tal policy f1 to ! ext5t o!rwise
 p]mitt$ "u ?is title-- 7,a7 d5y+ or    
condition+ ! issuance or effectiv5ess ( 
! policy or increas+ ! premium = an     
employ] bas$ on ! manife/ation ( a      

disease or disord] ( an individual :o is
 cov]$ "u ! policy2 or  7,b7 increas+ ! 
premium = any policy issu$ to an        
individual bas$ on ! manife/ation ( a   
disease or disord] ( an individual :o is
 cov]$ "u ! policy 79 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]s4  4  7b7 
,outrea* plan  7#a7 ,9 g5]al ,!         
,secret>y ( ,heal? & ,human ,s]vices    
%all develop an outrea* plan to notify  
individuals entitl$ to b5efits "u "p ,a 
or enroll$ "u "p ,b ( title ,,xviii ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 ( ! effects ( ! am5dm5t  
made by subsection 7a74  7#b7           
,consultation ,9 implem5t+ ! outrea*    
plan develop$ "u p>agraph 7#a71 !       
,secret>y %all consult ) consum]        
advocates1 brok]s1 insur]s1 ! ,national 
,association ( ,insurance ,commission]s1
 & ,/ate ,heal? ,insurance ,assi/ance   
,programs4  7c7 ,effective date2        
phase-,9 au?ority  7#a7 ,effective date 

,subject to p>agraph 7#b71 ! am5dm5t    
made by subsection 7a7 %all apply to    
m$ic>e supplem5tal policies effective on
 or aft] ,janu>y #a1 #bjbb4  7#b7       
,phase-9 au?ority  7,a7 ,9 g5]al        
,subject to subp>agraph 7,b71 !         
,secret>y ( ,heal? & ,human ,s]vices may
 phase 9 ! implem5tation ( ! am5dm5t    
made "u subsection 7a7 7) su* phase-9   
beg9n+ on or aft] ,janu>y #a1 #bjbb7 9  
su* mann] z ! ,secret>y det]m9es        
appropriate 9 ord] to m9imize any adv]se
 impact on individuals enroll$ "u a     
m$ic>e supplem5tal policy4  7,b7        
,phase-9 p]iod may n exce$ #e ye>s ,!   
,secret>y ( ,heal? & ,human ,s]vices    
%all ensure t ! am5dm5t made by         
subsection 7a7 is fully implem5t$ by n  
lat] ?an ,janu>y #a1 #bjbg4  #c4 ,m$ical
 loss ratio ,section #ahhb7r77#a77;,a7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciess7r77#a77;,a77 is am5d$-- 7#a7 by
 ins]t+ & p]iodically review$ aft]      
develop$2 &  7#b7 by /rik+ policy1 at   
lea/ #ge p]c5t ( ! aggregate am\nt (    

premiums collect$ 9 ! case ( gr\p       
policies & at lea/ #fe p]c5t 9 ! case ( 
individual policies2 & & ins]t+ !       
foll[+3 policy-- 7i7 ) respect to p]iods
 beg9n+ be=e ,janu>y #a1 #bjbb1 at lea/ 
#ge p]c5t ( ! aggregate am\nt ( premiums
 collect$ 9 ! case ( gr\p policies & at 
lea/ #fe p]c5t 9 ! case ( individual    
policies2 &  7ii7 ) respect to p]iods   
beg9n+ on or aft] ,janu>y #a1 #bjbb1 a  
p]c5t ( ! aggregate am\nt ( premiums    
collect$ t1 9 ! case ( gr\p policies or 
individual policies1 z applicable1 is   
equal to or great] ?an bo?-- 7,i7 !     
applicable p]c5t specifi$ 9 clause 7i7 )
 respect to su* policies2 &  7,,ii7 su* 
p]c5t z ! ,national ,association (      
,insurance ,commission]s may recomm5d to
 ! ,secret>y ) respect to su* policies =
 purposes ( ?is p>agraph2 &  4  #d4     
,limitations on pric+ discrim9ation  7a7
 ,9 g5]al ,section #ahhb ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #aciess71 
z am5d$ by section #f1 is fur!r am5d$ by
 add+ at ! end ! foll[+ new subsection3 

7aa7 ,developm5t ( new /&>ds relat+ to  
pric+ discrim9ation  7#a7 ,9 g5]al ,!   
,secret>y %all reque/ ! ,national       
,association ( ,insurance ,commission]s 
to review & revise ! /&>ds = all b5efit 
packages "u subsection 7p77#a71 includ+ 
! core b5efit package1 9 ord] to provide
 cov]age consi/5t ) p>agraph 7#b74 ,su* 
revisions %all be made consi/5t ) !     
rules applicable "u subsection          
7p77#a77;,e7 7) ! ref]5ce to ! #aiia    
,,naic ,model ,regulation deem$ a       
ref]5ce to ! ,,naic ,model ,regulation z
 mo/ rec5tly updat$ by ! ,national      
,association ( ,insurance ,commission]s 
to reflect previ\s *anges 9 law & !     
ref]5ce to date ( enactm5t ( ?is        
subsection deem$ a ref]5ce to ! date (  
enactm5t ( ?is subsection74  7#b7       
,*anges 9 co/-%>+ describ$ ,"u ! revis$ 
/&>ds1 cov]age %all n be available "u a 
,m$ic>e supplem5tal insurance policy    
unless ! issu] ( ! policy1 9 addition to
 con=m+ to ! o!r applicable requirem5ts 
( ?is section-- 7,a7 does n discrim9ate 

9 ! pric+ ( ! policy because ( ! age ( !
 individual to :om ! policy is issu$2   
7,b7 does n1 to an ext5t t jeop>dizes ! 
access to su* policy = individuals :o   
are eligible to p>ticipate 9 ! program  
"u ?is title because ! individuals are  
individuals describ$ 9 p>agraph 7#b7 or 
7#c7 ( section #ahaa1 discrim9ate 9 !   
pric+ ( ! policy because ! individual to
 :om ! policy is issu$ is s eligible to 
p>ticipate 9 su* program because !      
individual is an individual s describ$ 9
 su* a p>agraph2 &  7,c7 does n e/abli% 
premiums applicable "u su* policy on a  
basis t w\ld apply to a portion (1 b n !
 entirety (1 a c\nty or equival5t area  
specifi$ by ! ,secret>y4  7#c7          
,application date ,! revis$ /&>ds %all  
apply to b5efit packages sold1 issu$1 or
 r5ew$ "u ?is section to individuals :o 
fir/ become entitl$ to b5efits "u "p ,a 
or fir/ enrolls 9 "p ,b on or aft]      
,janu>y #a1 #bjbb4  4  7b7 ,con=m+      
am5dm5t ,section #ahhb7o77#a7 ( su* ,act
 7#db ,u4,s4,c4 #aciess7o77#a77 is am5d$

 by /rik+ 1 & 7y7 & ins]t+ 7y71 & 7aa74 
#e4 ,cl>ify+ b5efici>y options on !     
,m$ic>e plan f9d] website ,section #ahjd
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;b-#b7 is am5d$ by add+  
at ! end ! foll[+ new subsections3  7d7 
,9 ! case t ! ,secret>y provides = a    
,m$ic>e plan f9d] int]net website ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 7or 
a successor website71 ! ,secret>y %all1 
) respect to su* website & 9 accordance 
) subsection 7f7-- 7#a7 make available  
on su* website-- 7,a7 access to provid] 
networks 9 ord] to provide to           
individuals entitl$ to b5efits "u "p ,a 
or enroll$ "u "p ,b in=mation to assi/  
su* individuals 9 und]/&+ ! re/rictions 
on provid]s & pot5tial co/s entail$ by  
_! decisions reg>d+ enrollm5t "u p>ts ,a
 & ,b1 "u "p ,c1 & 9 m$ic>e supplem5tal 
policies "u section #ahhb2  7,b7 a      
review ( out-(-pocket exp5ditures1      
includ+ d$uctibles1 copaym5ts1          
co9surance1 mon?ly premiums1 & e/imat$  
annual out-(-pocket co/s1 display$      

ov]all & by compon5ts1 bas$ on ! be/    
available in=mation z det]m9$ by !      
,secret>y2 &  7,c7 dur+ ! p]iod prior to
 ,janu>y #a1 #bjbe1 in=mation reg>d+ !  
rules t1 9 ea* ,/ate1 p]ta9 to gu>ante$ 
issue ( m$ic>e supplem5tal heal?        
insurance policies prior to             
implem5tation ( ! provisions ( ! ,close 
! ,m$igap ,act ( #bjba &1 9 ! case t a  
,/ate has no su* rules p]ta9+ to        
gu>ante$ issue ( su* policies1 cle>     
language expla9+ ! implications ( su*   
lack ( rules = individuals ) pre-exi/+  
conditions2  7#b7 n lat] ?an ,janu>y #a1
 #bjbj1 & p]iodically !reaft]1 p]=m a   
review ( su* website 9 ord] to ensure t 
su* website makes available to          
individuals entitl$ to b5efits "u "p ,a 
or enroll$ "u "p ,b ! in=mation t !     
,secret>y det]m9es is necess>y = su*    
individuals to make in=m$ *oices reg>d+ 
_! options "u ! program "u ?is title2 & 
7#c7 n lat] ?an #ab mon?s aft] ! la/ day
 ( ea* p]iod = ! reque/ = in=mation "u  
subsection 7e71 update su* website1 tak+

 into consid]ation ! in=mation collect$ 
pursuant to su* subsection1 to cl>ify ! 
pres5tation ( consum] options = m$ic>e  
supplem5tal heal? insurance policy      
options1 includ+ by pres5t+ su*         
in=mation 9 a mann] calculat$ to be     
und]/ood by ! av]age consum] & 9 a mann]
 t-- 7,a7 improves consum] access to    
in=mation reg>d+ ! applicable premiums  
"u su* policy options z ( ! date on :i* 
su* website is s updat$2  7,b7          
facilitates consum]s' ability to comp>e 
& sort policy options & premium         
in=mation across plan (f]+s 9 a giv5    
location2  7,c7 cl>ifies & expla9s      
diff]5ces 9 policy value2  7,d7 rates & 
expla9s ! f9ancial /ability ( issu]s (  
su* policies2  7,e7 provides data on !  
inflation rate ( diff]5t policies2  7,f7
 provides in=mation reg>d+ ! gu>ante$   
issue requirem5ts t apply to m$ic>e     
supplem5tal heal? insurance policies "u 
section #ahhb7s77#c72 &  7,g7 includes  
su* g5]al in=mation z is det]m9$ by !   
,secret>y to be necess>y = individuals  

entitl$ to b5efits "u "p ,a or enroll$  
"u "p ,b to und]/& co/s "u ,,ma plans   
available pursuant to "p ,c &           
prescription drug plans available       
pursuant to "p ,d4  7e7 ,n lat] ?an #f  
mon?s aft] ! date ( ! enactm5t ( ?is    
subsection & beg9n+ on ,decemb] #g ( ea*
 ye> !reaft]1 ! ,secret>y ( ,heal? &    
,human ,s]vices %all provide an         
opportunity = public comm5t dur+ :i* !  
,secret>y reque/s in=mation1 includ+    
recomm5dations1 f /akehold]s reg>d+     
pot5tial improvem5ts to ! pres5tation ( 
m$ic>e supplem5tal heal? insurance      
policy options "u section #ahhb on !    
,m$ic>e plan f9d] int]net website ( !   
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices 7or 
a successor website74  7f7 ,) respect to
 any in=mation t ! ,secret>y makes      
available on ! ,m$ic>e plan f9d] int]net
 website ( ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices 7or a successor website7       
pursuant to subsection 7d71 ! ,secret>y 
%all1 prior to mak+ su* in=mation       
available-- 7#a7 provide1 9 consultation

 ) ! ,national ,association ( ,insurance
 ,commission]s1 an opportunity = consum]
 te/+ ( su* in=mation2  7#b7 %>e !      
results ( su* consum] te/+ ( su*        
in=mation ) int]e/$ /akehold]s2 &  7#c7 
provide a #fj-;day public comm5t p]iod )
 respect to su* in=mation4  4  #f4      
,re/or+ access to fir/-doll> ,m$igap    
cov]age ,section #ahhb ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #aciess7  
is am5d$ by /rik+ subsection 7z74  #g4  
,brok] transp>5cy ,section #aabh;,g ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g;h7 is am5d$-- 7#a7 9         
subsection 7c77#a77;,a71 by /rik+ #bjaa1
 & ins]t+ #bjaa 7or1 ) respect to       
in=mation requir$ to be submitt$ "u     
subsection 7f77#a71 n lat] ?an six mon?s
 aft] ! date ( ! enactm5t ( su*         
subsection712 &  7#b7 by add+ at ! end !
 foll[+ new subsection3  7f7            
,application to ,m$igap insurance brok]s
  7#a7 ,9 g5]al ,beg9n+ n lat] ?an #ab  
mon?s aft] ! date ( enactm5t ( ?is      
subsection1 ea* issu] ( a m$ic>e        

supplem5tal heal? insurance policy %all 
annually submit to ! ,secret>y a report 
reg>d+ paym5ts or o!r transf]s ( value  
made dur+ ! previ\s ye> to ag5ts1       
brok]s1 & o!r ?ird p>ties repres5t+ su* 
policy4 ,ea* su* report %all include !  
foll[+ in=mation1 ) respect to su* a    
paym5t or o!r transf] ( value3 7,a7 ,!  
"n ( ! recipi5t ( ! paym5t or o!r       
transf] ( value4  7,b7 ,! bus9ess       
address ( ! recipi5t4  7,c7 ,! am\nt ( !
 paym5t or o!r transf] ( value4  7,d7 ,!
 dates on :i* ! paym5t or transf] (     
value 0 provid$4  7,e7 ,a description ( 
! =m ( ! paym5t or transf] ( value4     
7,f7 ,any o!r categories ( in=mation !  
,secret>y det]m9es appropriate4  7#b7   
,application ( transp>5cy sy/em ,!      
provisions ( subsections 7b7 ?r\gh 7d7  
%all apply to an issu] describ$ 9       
p>agraph 7#a71 in=mation requir$ to be  
report$ "u su* p>agraph1 & ag5ts1       
brok]s1 & o!r ?ird p>ties describ$ 9 su*
 p>agraph 9 ! same mann] & to ! same    
ext5t z su* provisions apply to an      

applicable manufactur]1 in=mation       
requir$ to be report$ "u subsection 7a71
 & a cov]$ recipi5t4  4