HEALTH INSURANCE AND THE RECREATIONAL RIDER

Introduction

Regulations adopted in 2001 by the Internal Revenue Service, the Pension and Welfare Benefits Administration and the Health Care Financing Administration (now known as the Centers for Medicare and Medicaid Services) concerned horse owners and people who enjoy horseback riding (and other forms of recreation) because the federal provision permits health insurers to exclude coverage for injuries resulting from riding and other forms of “dangerous” recreation.

While the rules state that an employer cannot refuse health-care coverage to an employee based on participation in recreational activities, they permit health insurers to deny coverage for injuries sustained in connection with such recreational activities, effectively reaching the same result. 

Background

These proposed regulations permit exclusions from health insurance coverage based on activities, including horseback riding, that the AHC believes Congress sought to protect. 

In 1996, Congress passed the Health Insurance Portability and Accountability Act.  As we read this Act, it was intended to prohibit health insurers from denying health coverage based on a worker's pre-existing medical condition or participation in legal recreational activities.

The legislative history of the Act states that the law "is intended to ensure, among other things, that individuals are not excluded from health-care coverage due to their participation in activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing and other similar activities."

Recreational groups, including the American Horse Council, worked to have that language included in the legislative history of the Act because some employers and insurers were discriminating against recreationalists, leaving them without coverage if they were involved in recreational activities.  Incidents of discrimination involved the denial of health-care protection to employees not only involved in illegal activities, like driving a car while intoxicated, but also when involved in legal recreational activities, such as those mentioned above.

Legislation

On February 14, 2003, Senators Susan Collins (R-ME) and Russell Feingold (D-WI) introduced legislation (S. 423) in the Senate that would prohibit health insurers from denying benefits to plan participants if they are injured while engaging in legal recreational activities like horseback riding.

Representative Scott McInnis (R-CO) introduced an identical bill in the House of Representatives, H.R.1749, on April 10, 2003.   The McInnis bill has very strong support.

Current Status

The Senate bill was referred to the Senate Committee on Health, Education, Labor, and Pensions and a hearing was held on October 29, 2003. 

After the hearing, the language was been changed slightly because the Chairman of the Senate Committee on Health, Education, Labor and Pensions, Senator Judd Gregg (R-NH) and the Ranking Member of the Committee, Senator Ted Kennedy (D-MA) were concerned that by listing activities some groups could be unintentionally excluded.  Therefore, the new bill provides:

A group health plan, or a health insurance offering group health insurance in connection with a group health plan, may not deny benefits otherwise provided under the plan or coverage for the treatment of an injury solely because such injury resulted from the participation or beneficiary in a legal transportation or legal recreational activity.

In other words, the new language is much broader and essentially includes all legal recreational activities. 

The House bill has been referred to the Committee on Energy and Commerce in addition to the Committees on Education and the Workforce, and Ways and Means.  It has strong support with over 150 cosponsors. 

AHC Position

The AHC supports both bills currently under consideration by Congress.

If you would like mail out these two letters of support, the Oklahoma Horse Industry Council is listing our congressional delegation for your convenience: