| Issue |
Senate |
House (Passed in July) |
| Malpractice lawsuits |
No provision |
Modifies ERISA so patients have broader legal recourse to collect damages from insurer. Plans can be fined up to $250,000 for withholding coverage. |
| Malpractice damages |
No cap |
Sets a $250,000 ceiling on "pain & suffering" damages for patient awards. |
| Internal appeals |
Mandated process.
Complaints must be addressed within 30 days and 72 hours for medical emergencies. |
Mandated process with same decision deadlines as Senate plan. |
| External appeals |
Mandated binding process but limits reviews to medical expenses above $1,000 and experimental procedures. |
No limit on appeals but allows health plans to charge patients appealing between $25 and $100 or 10% of procedure. Plans not complying with results can be fined up to $250,000. |
| Gag rules |
Prohibits health plans from dictating to providers what treatment options may be discussed with patients. |
Beyond Senate bill, states doctor-patient conversations should not be restricted by health plan. |
| "HealthMarts" |
No provision |
Allows small businesses, insurers, and health care providers to form groups and purchase discounted health insurance. |
| Association health plans |
No provision |
Amends ERISA so church, trade, and business groups can form alliances and buy discounted health insurance. |
| Point-of-service option |
Required of employers with 50 or more workers but employees must pay cost difference. |
Required of employers except companies that offer insurance through HealthMarts or have insurance costs rise above 1 percent. |
