Health Insurance Consumer's Bill of Rights Act of 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 professional 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.