OCT 27 1992 The Honorable Phil Gramm United States Senator 2323 Bryan Street, #1500 Dallas, Texas

75201 Attention: Clarissa Clarke Dear Senator Gramm: This letter responds to your inquiry on behalf of (b)(6) concerning limitations on insurance coverage and the applicability of the Americans with Disabilities Act to her situation. The Americans with Disabilities Act (ADA) authorizes the Department of Justice to provide technical assistance to individuals and entities having rights or obligations under the Act. This letter provides informal guidance to assist your constituent in understanding the ADA's provisions. However, it does not constitutes a legal interpretation, and it is not binding on the Department. The provisions of the ADA applicable to insurance company practices are somewhat limited, and are set forth in Section 36.212 of the Department of Justice's title III regulation, a copy of which is enclosed. The provision appears on page 35596, and additional discussion on this issue is included in the regulatory preamble on pages 35562-3. Also enclosed is a copy of our title III Technical Assistance Manual, which includes information on this point on pages 18-9. We are unable to determine from the information provided whether the situation described by Ms. (b)(6) is a potential violation of title III of the ADA. If, after reviewing the enclosed information, Ms. (b)(6) believes there may be such a violation, she can proceed to remedy it by proceeding as described on pages 64-7 of the Manual. cc: Records; Chrono; Wodatch; Breen; McDowney; FOIA; MAF. :udd:jonessandra:ada.gramm2 01-01655​ -2-

There is also a possibility that Ms. (b)(6) may have a claim under title I of the ADA, which is enforced by the Equal Employment Opportunity Commission. It is clear from her letter that she has already forwarded the information to the EEOC, and I assume that she will hear from that agency concerning the title I ADA provisions that may apply. I hope this information assists you in responding to your constituent. Sincerely, John R. Dunne Assistant Attorney General Civil Rights Division Enclosures (2) 01-01656​Security 80/100 A COMPREHENSIVE MAJOR MEDICAL INSURANCE PLAN FOR INDIVIDUALS AND SMALL GROUPS ONE TO FOURTEEN LIVES NO PARTICIPATION REQUIREMENTS NO CONTRIBUTION REQUIREMENTS SIMPLIFIED UNDERWRITING FEW INDUSTRY RESTRICTIONS RIDERS AND WAIVERS AVAILABLE COMPANY BEST RATING A+ (SUPERIOR) MATERNITY PREVENTIVE MEDICAL CARE ADMINISTERED BY UNDERWRITTEN BY PROFESSIONAL BENEFITS DURHAM LIFE INSURANCE COMPANY ADMINISTRATION RALEIGH, NORTH CAROLINA

P.O. BOX 31810 DALLAS, TX 75231 A+ SUPERIOR BEST RATING 01-01657​ EMPLOYEE: All full time employees on the company payroll and working a minimum of 30 hours per week or more. NEW EMPLOYEES: First of the month following the completion of one month full time employment. DEPENDENT: Whenever used herein shall mean - (A) An employee's spouse and (B) unmarried child(ren) including stepchildren, legally adopted children, or foster children who have the same legal residence as the employee, who have not attained their 19th birthday, and who are not members of the armed forces; provided that any child over age 19, but less than 25, shall be considered as a dependent only if he is attending an accredited institution of learning as a full-time student and is primarily dependent on the employee for support and maintenance and claimed as an income tax deduction. GENERAL EXCLUSIONS: Charges for eye glasses, eye refractions and hearing aids, alcoholism or drug addiction, miscarriage, abortion, confinement or care in any government hospital or institution, charges in connection with war or an act of war or participation in a riot or insurrections; or self-inflicted injuries, or sickness, or an attempted suicide, while sane or insane; exogenous obesity; and any other expenses not necessitated by an accident or sickness, including male or female sterilization or reversals thereof, whether voluntary or otherwise. Charges for illness or injury arising out of the Military Service; charges which a person is not legally required to pay; treatment of corns, callouses, bunions, trimming of toenails except as provided in the Policy. Service or treatment due to altering the size or shape of the breast, or any other anatomical part of the body, male or female, whether voluntary or otherwise. Any care or treatment of the teeth or gums or for the fitting or wearing of dentures; or any care or treatment of teeth, jaws, or jaw joints, including, but not limited to: atrophy of the lower jaw; malocclusion; maxillo-facial surgery; tempero-mandibular joint dysfunction; and retrognathia; except for treatment of a congenital anomaly in a child born while the person is insured for Medical Expense Benefits under this plan. However, with respect to Section 11 - Benefits - Employee - Part EDMM - Employee and Dependent Major Medical Expense Insurance, this exclusion shall not apply to treatment of accidental injury to sound natural teeth (including their replacement) if the injury occurs while insured and the treatment is given within six months after the

date of the injury. Charges incurred for a deviated nasal septum, unless sustained in an accident which occurs while the person is a covered person under the Policy. GENERAL LIMITATIONS: Charges for Jaw, Dental and/or Cosmetic treatment or Surgery, except for charges resulting from an accident occurring while insured hereunder, and except for congenital defect in a newborn child. Psychiatric treatment out of hospital will be limited to a benefit of 50% of the eligible charge for treatment or consultation, up to a maximum eligible charge of $30.00 per treatment or consultation. Lifetime maximum of $5,000 on mental and nervous conditions for covered expenses incurred in and/or out of hospital. Charges for any care/service or supplies provided in connection with hernia, tonsillitis, adenoids; any disease or disorder of reproductive system, gall bladder, tuberculosis, cancer, tumor, varicose veins or rectal disease will not be considered eligible charges unless such charges are incurred after the end of 6 consecutive months, during which the medical expense benefits have continuously been in force for the covered person; provided, however, the covered person has satisfied all other conditions of the policy including the Pre-Existing Condition Limitation. Benefits payable for all charges for or in connection with an organ transplant are limited to a lifetime maximum of $25,000. No benefits are payable for charges related to the donor or for the organ itself. The maximum for all benefits payable while the person is a covered person under the policy for care or treatment related to or resulting from Acquired Immune Deficiency Syndrome (AIDS), on and after the date such disease has been diagnosed, shall be $10,000. For the purposes of this provision, care or treatment shall include, but not be limited to, care or treatment of conditions such as Kaposi's sarcoma, pneumonia, pneumocystitis, viral diseases, and other infectious diseases, but shall not include care or treatment of any disease or injury which is clearly not related to the person having contracted or having AIDS. Preventive medical care: $200 maximum per family per year; includes immunizations, mammograms, routine physicals and pap smears. Hospital charges incurred on Friday, Saturday or Sunday in connection with an admission on any of those days are excluded unless the admission is for: (a) an emergency condition requiring immediate medical care: or (b) diagnostic tests or procedures, or surgery if performed within 24 hours from the time of admission. RATE CHANGE: Based on claims experience - Any premium due date with 30 days advance written notice after completion of selected rate guarantee. Rate guarantee not valid if medical history provided is not complete and accurate.

TERMINATION: By Class - Non-payment of Premium - Material Misstatement. LIFE INSURANCE CONVERSION POLICY: If application is received within 31 days of employment termination. EXTENSION OF BENEFITS: Covered Medical expenses as a result of injury or sickness originating prior to the dates of termination of employment will be payable up to 12 months after termination providing the insured is wholly and continuously disabled as a result of such injury or sickness from the date of termination of employment to the date of incurred expense, however no benefits are payable for expenses incurred more than 3 months after termination of insurance with respect to the participating employer, or after the master policy terminates, or the date you or your dependents are covered under any other group plan, whichever occurs first. INSTRUCTIONS: PROCEDURE FOR SALE AND ENROLLMENT 1. Fill out name of company and "Date & Presented By" spaces on cost calculation page. 2. Select and circle plan of life and medical coverage and any optional plans of coverage desired. 3. Enter name, ages and dependent status for each employee on cost calculation page. 4. Use rates for proper coverage by age and dependent status and enter on cost calculation page. 5. Carry all rates totalled by benefit to the bottom of the cost calculation page. 6. Enter totals of columns one (1) thru four (4) and bring these figures to the right hand side of the cost calculation page under "PREMIUM SUMMARY" heading. 7. Add the $15.00 billing charge and the $1.00 per employee participation fee. 8. Total these figures. This total will be the first month's remittance and must be submitted with the application. 9. Complete the Employers Agreement and Subscription to the Trust and the agents statement which is on the reverse side of the cost calculation page and obtain the employers signature in the space provided. 10. Separate the cost calculation/Employers Agreement from the Outline of Benefits page and mail this page with the completed enrollment cards, a check for the first month's remittance, and include all material as requested by the underwriting requirements to: Professional Benefits Administration, Inc. P.O. Box 31810 Dallas, Texas 75231 214-349-1996

REV.8/89 01-01658​September 10, 1992 STATE BOARD OF INSURANCE P. O. Box 149091 Austin, TX 78714-9091 I applied for medical insurance with a group at the office. A period from about June 19th - August 6th, 1992 went by, along with an incurred cost to me to release medical records, and postage to cover our numerous correspondence. Finally a notice was sent stating the following "we must respectfully decline coverage on this applicant due to medical and underwriting regulations". Would this not be in writing somewhere under the General Exclusions or General Limitations in the handbook? Upon asking the agent over the phone if there was a medical or regulation number, she replied that she along with her head underwriter had decided this over the phone, and that there was nothing in writing to be seen. I HAD BEEN COMPLETELY HONEST AT THE OUTSET WITH THEM...COULD I NOT EXPECT THE SAME? It was explained to me that since I had sustained a spinal cord injury 20 years ago, and that I am ambulatory they could not risk protecting me from falls... CAN THEY ASSUME THAT I AM GOING TO FALL? They were going to exclude my lower extremities and my back, but since I am ambulatory, they could not risk against falls. Can't they cover me for a cold, or virus? I had a complete physical last year, with excellent results -- above the average as a matter of fact. My condition has been stable for some time now, and I am in great condition. I had insurance for 13 years with Prudential, and took my policy portable when I left my previous employer. After the second premium didn't arrive in the mail at my address, consequently I was cancelled with no notice--it was my word against the mail carriers, I guess. Here again my fate is decided over the phone. First of all, I am just wondering about some kind of pre-existing time frame on insurance. Not that I am planning in any way to take advantage of the coverage I can get -- I never have and never will. I do occasionally catch a cold or virus that perhaps an able bodied person passed on to me. I just want the peace of mind to know that if something catastrophic does happen, I would be covered. The least they could do would be refund the money that I paid to have my records released, knowing they were not going to cover me from the beginning.

I am wondering how this cannot be discrimination. It might help if someone would come out first hand to take the application and see whose fate they're deciding upon. In light of the Civil Rights Act of 1991, and the ADA (Americans with Disabilities) Regulations, treatment should be getting better to those of us making a significant contribution to society. NOW I AM FORCED TO USE THE TAXPAYERS DOLLARS FOR HEALTHCARE, AND I WOULD RATHER USE MY OWN MONEY. Respectfully submitted, (b)(6) Dallas, TX Enclosures cc: DEPARTMENT OF JUSTICE; Washington, DC EEOC REGULATIONS DEVELOPMENTS; Washington, DC CONGRESSMEN & SENATORS 01-01659