Federal Agencies Propose Adverse Rules on Health Insurance Coverage for Riders

Regulations proposed by the Internal Revenue Service, the Pension and Welfare Benefits Administration and the Health Care Financing Administration could affect people who enjoy horseback riding (and other forms of recreation) by permitting employers, labor unions and group health plans to deny benefits coverage for injuries resulting from riding and other forms of legal recreation.  While the new proposals state that an individual employee cannot be denied health-care coverage based on participation in recreational activities, they permit employers, unions and health insurers to deny benefits coverage for injuries sustained in connection with such recreational activities, effectively having the same result. The public has until April 9 to comment on the proposals.

These proposed regulations would 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 employers, unions and health insurers from denying health insurance coverage based on a worker's pre-existing medical condition or participation in various 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 those who recreate, leaving them without coverage if they were involved in these recreational activities.  Previous 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.

While the proposed rules prohibit a person from being excluded from a health insurance plan simply because he or she engages in riding, they permit an employer or insurer to include a “source of injury” provision in a policy that excludes coverage for benefits for injuries suffered while engaged in such activities.  This effectively excludes individuals engaged in such activities.  Clearly, Congress did not include the specific language quoted above in the legislative history of the Act to provide coverage for people who engage in recreational activities, only to be denied coverage in the event they sustain an injury while enjoying these activities. 

The AHC will submit comments to the federal agencies in opposition to this provision.  We urge any individual or equine organization to do likewise.  A sample letter follows.  Please retype it on your stationary and re-draft it to make it as personal as possible.  This will give it more weight. Send the same letter to each agency.  Do not simply send this memo in to the agencies. Comments must be submitted by April 9 to:

                                                                                    April X, 2001

Dear Sir or Madam:

We are writing in opposition to the regulations proposed by your agency under the Health Insurance Portability and Accountability Act (HIPAA).

Like tens of millions of other American we enjoy horseback riding.  We participate as follows……  Obviously, if we are unable to purchase health insurance, including benefits coverage, that protects us as we participate in this legal activity, it will affect our continued participation.

These rules will affect more than just us.  An economic study commissioned by the American Horse Council shows that recreational horseback riding has a $23.8 billion economic impact in the U.S., supports 317,000 jobs and involves 3 million horses. This segment of the American horse industry is growing rapidly.  Horse owners, breeders, stables, outfitters, dude ranches, veterinarians and feed and tack stores all rely on the individual rider.  The rules as proposed by your agency will adversely affect this entire industry.

We support the original Congressional intent of the bill, which is to protect individuals like horseback riders from being discriminated against and denied health insurance coverage, including benefits,  simply because they are participating in a legal, recreational activity.  The proposed rules suggest that plans may limit or deny benefits for injuries that result from participation in recreational activities.  This is directly opposite to the intent of Congress. 

We suggest that the proposed rules be amended to provide that if a group health plan generally provides benefits for a type of injury, the plan may not deny benefits otherwise provided for treatment of the injury if it results from participation in horseback riding and other recreational activities.

Thank you for your consideration.

Sincerely,