Sec. 2. Prohibiting certain health plans from applying a deductible to outpatient pediatric services
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/bill/116/hr/8573/ih/section-2A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subpart B of part 7 of title I of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section: A group health plan and a health insurance issuer offering group health insurance coverage may not impose any deductible under such plan or coverage (as applicable) with respect to outpatient pediatric services (as defined in subsection (b)) for which benefits are provided under such plan or coverage. For purposes of subsection (a), the term outpatient pediatric services means any item or service furnished to an individual under the age of 18 as an outpatient by a health care provider acting within the scope of such provider’s license, regardless of whether such service is furnished in-person or through use of a telecommunications system. .
The table of contents of the Employee Retirement Income Security Act of 1974 is amended by inserting after the item relating to section 714 the following: Sec. 715. Additional market reforms. Sec. 716. Prohibition on application of deductible to outpatient pediatric services. . Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq.) is amended by adding at the end the following new section: A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any deductible under such plan or coverage (as applicable) with respect to outpatient pediatric services (as defined in subsection (b)) for which benefits are provided under such plan or coverage.
For purposes of subsection (a), the term outpatient pediatric services means any item or service furnished to an individual under the age of 18 as an outpatient by a health care provider acting within the scope of such provider’s license, regardless of whether such service is furnished in-person or through use of a telecommunications system. . Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section: A group health plan may not impose any deductible under such plan with respect to outpatient pediatric services (as defined in subsection (b)) for which benefits are provided under such plan.
For purposes of subsection (a), the term outpatient pediatric services means any item or service furnished to an individual under the age of 18 as an outpatient by a health care provider acting within the scope of such provider’s license, regardless of whether such service is furnished in-person or through use of a telecommunications system. . The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new items:
Sec. 9815. Additional market reforms. Sec. 9816. Prohibition on application of deductible to outpatient pediatric services. . Section 1916A of the Social Security Act ( 42 U.S.C. 1396o–1 ) is amended— in subsection (a)— in paragraph (1), by striking paragraph
(2)and inserting paragraphs
(2)and
(4); and by adding at the end the following new paragraph: A State may not impose a deduction under the plan with respect to outpatient pediatric services (as defined in subsection (f)). ; and by adding at the end the following new subsection: For purposes of this section, the term outpatient pediatric services means any item or service furnished to an individual under the age of 18 as an outpatient by a health care provider acting within the scope of such provider’s license, regardless of whether such service is furnished in-person or through use of a telecommunications system. . Section 2103(e) of the Social Security Act ( 42 U.S.C. 1397cc ) is amended by adding at the end the following new paragraph: The State child health plan may not impose a deductible with respect to outpatient pediatric services (as defined in subparagraph (B)). For purposes of this paragraph, the term outpatient pediatric services means any item or service furnished to an individual under the age of 18 as an outpatient by a health care provider acting within the scope of such provider’s license, regardless of whether such service is furnished in-person or through use of a telecommunications system. . Section 226(c)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following new subparagraph: A plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for outpatient pediatric services (as defined in section 9816(b)). . Section 1095d of title 10, United States Code, is amended— in the section heading, by inserting before prohibition on and ; waiver by redesignating subsections
(a)and
(b)as subsections
(b)and (c), respectively; by inserting before subsection (b), as so redesignated, the following new subsection (a): The Secretary of Defense may not impose any deductible under the TRICARE program for medical care provided to a covered beneficiary who is under the age of 18 as an outpatient, regardless of whether such care is furnished in-person or through use of a telecommunications system. ; and in subsection (b), as so redesignated, by striking The Secretary and inserting In addition to the requirement under subsection (a), the Secretary . The table of sections at the beginning of chapter 55 of title 10, United States Code, is amended by striking the item relating to section 1095d and inserting the following new item: 1095d. TRICARE program: prohibition on and waiver of certain deductibles. . Section 1075(d) of such title is amended by adding at the end the following new paragraph: The Secretary may not impose any deductible amounts for outpatient pediatric services pursuant to section 1095d of this title. . Not later than 4 years after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study and submit to Congress a report on the effects of the amendments made by this Act on premiums, deductibles, and copayment and coinsurance requirements with respect to group health plans and group and individual health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act ( 42 U.S.C. 300gg–91 )). The amendment (or amendments) made by— subsections
(a)through
(c)and subsections
(f)and
(g)shall apply with respect to plan years beginning on or after the date that is 2 years after the date of the enactment of this Act; subsection
(d)shall apply with respect to medical assistance furnished in calendar quarters beginning on or after the date that is 2 years after the date of the enactment of this Act; and subsection
(c)shall apply with respect to child health assistance furnished calendar quarters described in paragraph (2).
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- 42 USC 300gg–11
- 42 USC 1396o–1
- 42 USC 300gg–91
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Sec. 2
Prohibiting certain health plans from applying a deductible to outpatient pediatric services
Cite42 USC 300gg–11
Cite42 USC 1396o–1
Cite42 USC 300gg–91
Cites 5Cited by 0 across 0 sources