Health Insurance Consumer's Bill of Rights Act of 1997
Read twice and referred to the Committee on Labor and Human Resources.
Congressional Research Service
Official summary
Version 00 · Introduced in Senate · Nov 9, 1997
TABLE OF CONTENTS: Title I: Health Insurance Bill of Rights Title II: Application of Bill of Rights Under Various Laws Health Insurance Consumer's Bill of Rights Act of 1997 - Title I: Health Insurance Bill of Rights - Amends the Public Health Service Act to require a managed care group health plan (and a health insurer offering group coverage) to: (1) have a sufficient number and mix of primary care practitioners and specialists throughout the service area; (2) provide specialty care access, standing referrals, access to nonparticipating providers, and access without referrals to professionals trained in obstetrics and gynecology (allowing a provider trained in obstetrics and gynecology to be designated as a primary care practitioner); (3) not (if emergency services are covered) require prior authorization for services for emergencies (defined from the perspective of a prudent layperson); (4) not deny participation in, deny or limit coverage, or discriminate against a qualified enrollee (with a life-threatening or serious illness for which no standard treatment is effective) for participation in clinical trials; (5) provide coverage continuity when coverage is terminated; (6) not restrict medical communications between a health professional and the professional's patient; (7) disclose (if prescription drugs are covered but limited to a formulary) to enrollees the nature of the restrictions and make restriction exceptions when medically necessary or appropriate; (8) comply with certain utilization review requirements, including regarding a complaint and appeals process; (9) have an ongoing quality improvement program; (10) not discriminate on specified bases, including disability, genetic makeup, health status, payer source, or anticipated need for services; (11) ensure confidentiality; (12) provide enrollees and prospective enrollees with a prospectus containing specified information, including qualitative and quantitative information; and (13) not limit the manner in which particular covered services are delivered if medically necessary or appropriate. Title II: Application of Bill of Rights under Various Laws - Requires health insurers to comply with title I of this Act regarding group and individual coverage. Allows States to establish requirements at least as stringent on insurers as the requirements of title I of this Act. Amends the Health Insurance Portability and Accountability Act of 1996 to provide for coordination by the Secretaries of the Treasury, Health and Human Services, and Labor regarding regulations, rulings, and interpretations concerning health insurance provisions of the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code. (Sec. 202) Amends ERISA to require group health plans (and insurers offering group coverage) to comply with title I of this Act. Allows States to establish requirements at least as stringent on insurers as the requirements of title I of this Act. (Sec. 204) Amends title XVIII (Medicare) of the Social Security Act to require each Medicare+Choice organization offering a Medicare+Choice plan described in specified provisions to comply with title I of this Act, except when Medicare requirements are more protective of enrollees. Amends title XIX (Medicaid) of the Social Security Act to allow Medicaid managed care organizations to not comply with Public Health Service Act health insurance requirements when those requirements are less protective of enrollees than Medicaid. Amends Federal law relating to the Federal Employees' Health Benefits Program to require plans offered under that Program to comply with title I of this Act, except when the Program's requirements are more protective of enrollees.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Aug 21, 2025. Consult Congress.gov for the current record.
AI Conversation Starters
Explore the bill from different angles
Choose a perspective, copy a prompt, and paste it into your preferred AI. Each prompt includes the bill version and available official source links, and asks for counterarguments as well as supporting evidence.
Neutral evidence review
Objective
Analyze S.1499 as objectively as possible. Explain its main provisions, who would be affected, possible benefits and harms, implementation, exceptions, and uncertainties. Present the strongest arguments for and against it, and identify evidence needed to assess its public impact.
View full prompt & sources
Fairness and public impact
Progressive lens
Examine S.1499 through a progressive lens, focusing on fairness, access, economic inequality, and effects on vulnerable communities. Explain potential benefits, costs, and unintended consequences. Consider the strongest counterarguments and distinguish stated goals from demonstrated outcomes.
View full prompt & sources
Institutions and government scope
Conservative lens
Examine S.1499 through a conservative lens, focusing on fiscal responsibility, institutional stability, federalism, and the scope of government. Explain potential benefits, costs, and unintended consequences. Consider the strongest counterarguments and any provisions that challenge this perspective.
View full prompt & sources
Individual rights and government power
Liberty lens
Examine S.1499 through a civil-liberties and limited-government lens. Consider individual rights, privacy, voluntary choice, accountability, and government power. Explain tradeoffs, possible safeguards, and the strongest counterarguments without assuming the proposal is beneficial or harmful.