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US Laws | Affordable Health Care Act (HR3950F)

TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS (1)(Text)

Subtitle A--Immediate Improvements in Health Care Coverage for All Americans (2)(Text)

SEC. 1001. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT. (3)(Text)

Part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended-- (4)

(1) by striking the part heading and inserting the following: (5)

"PART A--INDIVIDUAL AND GROUP MARKET REFORMS"; (6)

(2) by redesignating sections 2704 through 2707 as sections 2725 through 2728, respectively; (7)

(3) by redesignating sections 2711 through 2713 as sections 2731 through 2733, respectively; (8)

(4) by redesignating sections 2721 through 2723 as sections 2735 through 2737, respectively; and (9)

(5) by inserting after section 2702, the following: (10)

"Subpart II--Improving Coverage (11)

SEC. 2711. NO LIFETIME OR ANNUAL LIMITS. (12)

"(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish-- (13)

"(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or (14)

"(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary. (15)

"(b) Per Beneficiary Limits- Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law. (16)

SEC. 2712. PROHIBITION ON RESCISSIONS. (17)

"A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b). (18)

SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES. (19)

"(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for-- (20)

"(1) evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force; (21)

"(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and (22)

"(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. (23)

"(4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph. (24)

"(5) for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009. (25)

Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force. (26)

"(b) Interval- (27)

"(1) IN GENERAL- The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline. (28)

"(2) MINIMUM- The interval described in paragraph (1) shall not be less than 1 year. (29)

"(c) Value-based Insurance Design- The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs. (30)

SEC. 2714. EXTENSION OF DEPENDENT COVERAGE. (31)

"(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age. Nothing in this section shall require a health plan or a health insurance issuer described in the preceding sentence to make coverage available for a child of a child receiving dependent coverage. (32)

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