PlainBillCongress, translated.Legislation. Context. Public interest.Committee on Labor and Human Resources. Hearings held.
Congressional Research Service
Version 00 · Introduced in Senate · Feb 25, 1997
Health Insurance Bill of Rights Act of 1997 - Amends the Public Health Service Act to require a health insurance issuer under provisions of this Act to comply with certain notice requirements of the Employee Retirement Income Security Act of 1974 (ERISA). Requires an issuer, if coverage provides any emergency services benefits, to cover emergency services without authorization, participating provider, or (subject to exception) other restrictions. Requires an issuer, if the issuer requires or provides for an enrollee to designate a participating primary care provider, to permit a female enrollee to designate an obstetrics and gynecology specialist as the enrollee's primary care provider. Prohibits an issuer, if an enrollee has not designated such a specialist as a primary care provider, from requiring prior authorization for coverage of routine gynecological care and pregnancy-related services provided by such a specialist. Requires an issuer to refer to a specialist an enrollee who requires treatment by a specialist. Provides, in certain circumstances, for: (1) a specialist to provide and coordinate an enrollee's primary and specialty care; and (2) standing referrals. Requires an issuer, if a contract between the issuer and a provider is terminated, to permit an enrollee undergoing a course of treatment to continue with the provider during a transitional period. Requires an issuer to permit each enrollee to receive: (1) primary care from any available participating primary care provider; and (2) subject to limitation, specialty care from any available qualified participating provider. Prohibits issuer discrimination against an enrollee on the basis of the enrollee's participation in a clinical study or investigation approved and funded by specified Federal agencies. Regulates coverage of prescription drugs when an issuer uses a formulary. Requires issuers to: (1) maintain a quality assurance and improvement program; (2) collect uniform quality data; (3) have a written process for the selection of participating professionals; (4) maintain a drug utilization program; (5) conduct utilization review; (6) disclose specified information to enrollees and prospective enrollees; (7) ensure compliance with confidentiality laws; and (8) maintain a complaints and appeals system. Authorizes appropriations for grants to States to establish and maintain a Health Insurance Ombudsman. Prohibits agreements between issuers and providers from: (1) restricting the provider from engaging in medical communications with a patient (allowing the issuer to advise of the coverage's limitations on particular services based on the religious or moral convictions of the issuer); or (2) transferring to the provider any liability relating to actions or omissions of the issuer or agent. Imposes requirements on physician incentive plans. Prohibits an issuer from limiting the manner in which covered services are delivered. Requires each health issuer to comply with patient protection requirements of this Act regarding group and individual health insurance coverage it offers. Allows a State to establish requirements at least as stringent on issuers as the requirements of this Act. Amends ERISA to require a group health plan and an issuer to comply with the requirements of this Act. Directs the Secretary of Labor, for group health plans that provide benefits other than through health insurance coverage, to establish a Federal Group Health Plan Ombudsman. Allows a State to establish requirements at least as stringent on issuers as the requirements of this Act.
People & committees
Sen. Kennedy, Edward M. [D-MA] · D–MA
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
Committee on Labor and Human Resources. Hearings held.
Committee on Labor and Human Resources. Hearings held.
Read twice and referred to the Committee on Labor and Human Resources.
Sponsor introductory remarks on measure. (CR S1559)
Introduced in Senate
Primary sources
Text links open the official source. We currently store references to these documents.
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
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.
Analyze S.353 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.
Examine S.353 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.
Examine S.353 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.
Examine S.353 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.