article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Insurance Disclosure Act of 1997''. SEC. 2. DEFINITIONS. As used in this Act: (1) Insurer.--The term ``insurer'' means any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society, or other legal entity engaged in the business of insurance, including agents, brokers, adjusters, and third party administrators. The term also includes health benefit plans, health carriers, and life, disability, and property and casualty insurers. (2) Health benefit plan.--The term ``health benefit plan'' means any public or private entity or program that provides for payments for health care, including-- (A) a group health plan (as defined in section 2791(a)(1) of the Public Health Service Act (42 U.S.C. 300gg-91(a)(1)), section 733(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(a)(1)), or section 5000(b)(1) of the Internal Revenue Code of 1986)); (B) a multiple employer welfare arrangement (as defined in section 3(40) of the Employee Retirement Income Security Act (29 U.S.C. 1002(40))) that provides benefits consisting of medical care (as defined in section 733(a)(2) of such Act (29 U.S.C. 1191b(a)(2))), including items and services paid for as medical care; (C) any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract; (D) workers' compensation or similar insurance to the extent that it relates to workers' compensation medical benefits (as defined in regulations of the Secretary); (E) automobile medical insurance to the extent that it relates to medical benefits (as defined in regulations of the Secretary); and (F) any other insurance providing for enrollees medical benefits (as defined in regulations of the Secretary) in the event of sickness, accident, disability, death, or unemployment. (3) Health carrier.--The term ``health carrier'' means a person that contracts or offers to contract on a risk-assuming basis to provide, deliver, arrange for, pay for, or reimburse any of the cost of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services. (4) Policy.--The term ``policy'' means a contract of insurance, certificate, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders to an insurance policy or contract. (5) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. SEC. 3. ACCESS BY EXAMINED INDIVIDUAL TO RESULTS OF MEDICAL EXAMINATIONS. An insurer shall take such actions as are necessary to ensure that, in any case in which-- (1) a medical examination of an individual is required for initial or continued enrollment under a policy issued by the insurer, and (2) such medical examination is conducted by a person who is in the employ of the insurer or whose services are procured otherwise by the insurer, such individual (or the individual's legal guardian) is provided all medical information obtained from such examination at the same time that such information is made available to the insurer and is encouraged to make such information available to such individual's own physician. SEC. 4. ENFORCEMENT. (a) Applicability of Certain Public Health Service Act Provisions.-- (1) In general.--For purposes of sections 2722 and 2723 of the Public Health Service Act (42 U.S.C. 300gg-22, 300gg-23), the provisions of section 3 shall be deemed provisions of part A of title XXVII of such Act. For purposes of sections 2761 and 2762 of such Act (42 U.S.C. 300gg-45, 300gg-46), the provisions of section 3 shall be deemed provisions of part B of such title XXVII. (2) Rules of construction.--In applying such sections 2722, 2723, 2761 and 2762, and section 2791(d) of such Act (42 U.S.C. 300gg-91(d)) pursuant to paragraph (1)-- (A) any reference to a ``health insurance issuer'' shall be deemed a reference to an insurer (as defined in section 2(1))); (B) any reference to ``health insurance coverage'' (including any such coverage offered in connection with a group health plan) shall be deemed a reference to a policy (as defined in section 2(4)); (C) any reference to a ``group health plan'' shall be deemed a reference to a group insurance plan (as defined in section 111(b)(1) of the Employee Retirement Income Security Act of 1974, and subject to the same rules as apply with respect to group health plans under section 2721(a) of the Public Health Service Act (42 U.S.C. 300gg-21(a))); and (D) any reference to part A or part B of title XXVII of such Act shall be deemed a reference to sections 2 through 6 of this Act. (b) Private Cause of Action.-- (1) In general.--An individual who believes that he or she has been adversely affected by an act or practice of an insurer in violation of section 3 may maintain an action against the insurer in a Federal or State court of original jurisdiction. Upon proof of such conduct by a preponderance of the evidence, the court may award appropriate relief, including temporary, preliminary, and permanent injunctive relief and compensatory and punitive damages, as well as the costs of suit and reasonable fees for the aggrieved individual's attorneys and expert witnesses. With respect to compensatory damages, the aggrieved individual may elect, at any time prior to the rendering of final judgment, to recover in lieu of actual damages, an award of statutory damages in the amount of $10,000 for each violation. It shall be the duty of the Federal courts to advance on the docket and to expedite to the greatest possible extent the disposition of any action for temporary or preliminary injunctive relief considered under this paragraph. (2) Additional provisions relating to jurisdiction, venue, attorney's fees, etc.-- (A) In general.--Subject to subparagraph (B), subsections (d), (e), (f), (g), (h), and (j) of section 502 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1132(d), (e), (f), (g), (h), and (j)) shall apply with respect to a cause of action under paragraph (1) in the same manner and to the same extent as such subsections apply with respect to a cause of action under section 502(a)(1)(B) of such Act (29 U.S.C. 1132(a)(1)(B)). (B) Rules of construction.--In applying such subsections pursuant to subparagraph (A)-- (i) any reference to a ``participant'' or ``beneficiary'' shall be deemed a reference to the aggrieved individual referred to in paragraph (1); (ii) any reference to an ``employee benefit plan'' shall be deemed a reference to an insurer (as defined in section (2)(A)); (iii) any reference to the Secretary of Labor or the Secretary of the Treasury shall be deemed a reference to the Secretary of Health and Human Services; and (iv) any reference to title I of such Act shall be deemed a reference to sections 2 through 6 of this Act. SEC. 5. EFFECT ON STATE LAW. (a) In General.--Section 3 supersedes any provision of State law which is inconsistent with any provision of such section, in terms of providing less protection to individuals than is provided by such section, but only to the extent of such inconsistency. Nothing in section 3 shall be construed to-- (1) alter or relieve any insurer from the obligation to comply with any State law with respect to insurers, policies, and health benefit plans, except to the extent that such law is inconsistent with any provision of section 3, or (2) preclude a State from enacting any law or regulation that affords a greater level or broader range of protections to individuals under policies or health benefit plans. (b) Definitions.--For purposes of this section, the terms ``State'' and ``State law'' have the meanings provided such terms under section 514(c) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(c)). SEC. 6. REGULATIONS. The Secretary (in consultation with the Secretary of Labor) shall prescribe regulations to carry out the provisions of sections 2 through 5. SEC. 7. ERISA REQUIREMENTS FOR DISCLOSURE BY GROUP INSURANCE PLANS TO PARTICIPANTS AND BENEFICIARIES OF THEIR MEDICAL CONDITION LEARNED IN THE COURSE OF MEDICAL EXAMINATIONS REQUIRED FOR COVERAGE UNDER SUCH PLANS. (a) In General.--Part 1 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended-- (1) by redesignating section 111 (29 U.S.C. 1031) as section 112; and (2) by inserting after section 110 (29 U.S.C. 1030) the following new section: ``disclosure to participants and beneficiaries of results of medical examinations conducted by group insurance plans ``Sec. 111. (a) In General.--A group insurance plan, and any insurer offering a policy in connection with such plan, shall take such actions as are necessary to ensure that, in any case in which-- ``(1) a medical examination of a participant or beneficiary is required for initial or continued eligibility for benefits, and ``(2) such medical examination is conducted by a person who is in the employ of the plan or the insurer or whose services are procured otherwise by the plan or the insurer, such participant or beneficiary (or his or her legal guardian) is provided all medical information obtained from such examination at the same time that such information is made available to the plan or insurer and is encouraged to make such information available to his or her own physician. ``(b) Definitions.--For purposes of this section-- ``(1) Group insurance plan.--The term `group insurance plan' means an employee welfare benefit plan established and maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death, or unemployment. ``(2) Policy.--The term ``policy'' means a contract of insurance, certificate, indemnity, suretyship, or annuity, including endorsements or riders to an insurance policy or contract. ``(c) Effect on State Law.--This section supersedes any provision of State law which is inconsistent with any provision of this section, in terms of providing less protection to participants and beneficiaries than is provided by this section, but only to the extent of such inconsistency. Nothing in this section shall be construed to-- ``(1) alter or relieve any plan administrator from the obligation to comply with the laws of any State with respect to group insurance plans, except to the extent that such laws are inconsistent with any provision of this section, or ``(2) preclude a State from enacting any law or regulation that affords a greater level or broader range of protections to participants and beneficiaries under group insurance plans. ``(d) Expedited Consideration.--It shall be the duty of the Federal courts to advance on the docket and to expedite to the greatest possible extent the disposition of any action under section 502 for temporary or preliminary injunctive relief from violations of this section. ``(e) Regulations.--The Secretary (in consultation with the Secretary of Health and Human Services) shall prescribe regulations to carry out the provisions of this section.''. (b) Penalties at $100 a Day for Failure to Disclose.--Section 502(c)(1)(A) of such Act (29 U.S.C. 1132(c)(1)(A)) is amended by striking ``or section 101(e)(1)'' and inserting ``, section 101(e)(1), or section 111(a)''. (c) Conforming Amendment.--The table of contents in section 1 is amended by striking the item relating to section 111 and inserting the following new items: ``Sec. 111. Disclosure to participants and beneficiaries of results of medical examinations conducted by group insurance plans. ``Sec. 112. Repeal and effective date.''. SEC. 8. EFFECTIVE DATE. Sections 2, 3, 4, 5, and 6 shall apply with respect to any action taken on or after the date of the enactment of this Act. The amendments made by section 7 shall apply with respect to plan years beginning on or after such date.
summary: Insurance Disclosure Act of 1997 - Requires insurers, if a medical exam (procured by the insurer) is required for initial or continued enrollment, to: (1) provide the individual involved with all medical information obtained from the exam; and (2) encourage the individual to make the information available to the individual's physician. Deems the above requirements to be provisions of the Public Health Service Act for purposes of provisions relating to enforcement, preemption, State flexibility, and construction. Provides for a private cause of action, including applying certain civil enforcement provisions of the Employee Retirement Income Security Act of 1974 (ERISA). Supersedes any State law providing less protection to individuals. (Sec. 7) Amends ERISA to require a group insurance plan, and any insurer offering a policy in connection with such plan, if a medical exam (procured by the insurer) is required for initial or continued eligibility for benefits, to: (1) provide the individual involved with all medical information obtained from the exam; and (2) encourage the individual to make the information available to the individual's physician. Supersedes any State law providing less protection to individuals. Makes an administrator who fails or refuses to comply liable to the individual for up to $100 per day. Allows other relief.