Key Elements of the Senate's Patients' Rights Bill

PATIENTS' RIGHTS – All Americans with private or public health insurance are guaranteed access to emergency care and medical specialists, including gynecologists and pediatricians, needed medicines and care during clinical trials.

FEDERAL COURTS Most patients can sue in federal court over benefits, including disputes about contracts, co-payments and other nonmedical judgments.

STATE COURTS Patients can sue insurers in state courts over coverage denials if based on medical judgment.

CLASS ACTION LAWSUITS Class-action lawsuits restricted to employees of one company and one health care plan. Employees of different companies could not join together in a suit.

DAMAGES LIMITS In state courts, no limits for wages and other economic losses, pain and suffering or punitive damages unless a state's law imposes them. In federal courts, no limits for wages, pain and suffering and other losses; a $5 million limit on punitive damages.

INDEPENDENT REVIEWS OF PLAN DECISIONS Patients are generally required to exhaust outside appeals before suing. In special circumstances, lawsuits would be allowed during the appeals process.

EMPLOYERS Most employers shielded from lawsuits unless they directly helped make a decision against a patient. Only companies that offer self-insured and self-administered insurance plans would be exposed to legal liability, and even they could protect themselves if they found an outside entity to assume the risk.