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29 U.S.C. § 1191a — Special rules relating to group health plans

Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 1191a — Special rules relating to group health plans

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Source file: Laws/federal/codes/united-states-code/title-29/section-1191a-special-rules-relating-to-group-health-plans--ba36f3e2db.md
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Source location: Title 29, Chapter 18, § 1191a; chapter-018-employee-retirement-income-security-program.md

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**(a) General exception for certain small group health plans** The requirements of this part (other than [section 1185 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185&num=0&edition=prelim)) shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of such plan year, such plan has less than 2 participants who are current employees. **(b) Exception for certain benefits** The requirements of this part shall not apply to any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in [section 1191b(c)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b/c/1&num=0&edition=prelim). **(c) Exception for certain benefits if certain conditions met** (1) **Limited, excepted benefits** — The requirements of this part shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in [section 1191b(c)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b/c/2&num=0&edition=prelim) if the benefits— (A) are provided under a separate policy, certificate, or contract of insurance; or (B) are otherwise not an integral part of the plan. (2) **Noncoordinated, excepted benefits** — The requirements of this part shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in [section 1191b(c)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b/c/3&num=0&edition=prelim) if all of the following conditions are met: (A) The benefits are provided under a separate policy, certificate, or contract of insurance. (B) There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor. (C) Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor. (3) **Supplemental excepted benefits** — The requirements of this part shall not apply to any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in [section 1191b(c)(4) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b/c/4&num=0&edition=prelim) if the benefits are provided under a separate policy, certificate, or contract of insurance. **(d) Treatment of partnerships** For purposes of this part— (1) **Treatment as a group health plan** — Any plan, fund, or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or program provides medical care (including items and services paid for as medical care) to present or former partners in the partnership or to their dependents (as defined under the terms of the plan, fund, or program), directly or through insurance, reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare benefit plan which is a group health plan. (2) **Employer** — In the case of a group health plan, the term “employer” also includes the partnership in relation to any partner. (3) **Participants of group health plans** — In the case of a group health plan, the term “participant” also includes— (A) in connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership, or (B) in connection with a group health plan maintained by a self-employed individual (under which one or more employees are participants), the self-employed individual, if such individual is, or may become, eligible to receive a benefit under the plan or such individual’s beneficiaries may be eligible to receive any such benefit.

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Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 1191b — Definitions

**(a) Group health plan** For purposes of this part— (1) **In general** — The term “group health plan” means an employee welfare benefit plan to the extent that the plan provides medical care (as defined in paragraph (2) and including items and services paid for as medical care) to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Such term shall not include any qualified small employer health reimbursement arrangement (as defined in [section 9831(d)(2) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9831/d/2&num=0&edition=prelim)). (2) **Medical care** — The term “medical care” means amounts paid for— (A) the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body, (B) amounts paid for transportation primarily for and essential to medical care referred to in subparagraph (A), and (C) amounts paid for insurance covering medical care referred to in subparagraphs (A) and (B). **(b) Definitions relating to health insurance** For purposes of this part— (1) **Health insurance coverage** — The term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer. (2) **Health insurance issuer** — The term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organ

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1191b

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Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 1181 — Increased portability through limitation on preexisting condition exclusions

**(a) Limitation on preexisting condition exclusion period; crediting for periods of previous coverage** Subject to subsection (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if— (1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date; (2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and (3) the period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1)) applicable to the participant or beneficiary as of the enrollment date. **(b) Definitions** For purposes of this part— (1) **Preexisting condition exclusion** (A) *In general* — The term “preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. (B) *Treatment of genetic information* — Genetic information shall not be treated as a condition described in subsection (a)(1) in the absence of a diagnosis of the condition related to such information. (2) **Enrollment date** — The term “enrollment date” means, with respect to an individual covered under a group health plan or health insurance coverage, the date of e

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1181

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Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 1003 — Coverage

**(a) In general** Except as provided in subsection (b) or (c) and in sections 1051, 1081, and 1101 of this title, this subchapter shall apply to any employee benefit plan if it is established or maintained— (1) by any employer engaged in commerce or in any industry or activity affecting commerce; or (2) by any employee organization or organizations representing employees engaged in commerce or in any industry or activity affecting commerce; or (3) by both. **(b) Exceptions for certain plans** The provisions of this subchapter shall not apply to any employee benefit plan if— (1) such plan is a governmental plan (as defined in [section 1002(32) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1002/32&num=0&edition=prelim)); (2) such plan is a church plan (as defined in [section 1002(33) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1002/33&num=0&edition=prelim)) with respect to which no election has been made under [section 410(d) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section410/d&num=0&edition=prelim); (3) such plan is maintained solely for the purpose of complying with applicable workmen’s compensation laws or unemployment compensation or disability insurance laws; (4) such plan is maintained outside of the United States primarily for the benefit of persons substantially all of whom are nonresident aliens; or (5) such plan is an excess benefit plan (as defined in [section 1002(36) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1002/36&num=0&edition=prelim)) and is unfunded. The provisions of part 7 of subtitle B of this subchapter shall not apply to a health insurance issuer (as defined i

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1003

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Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 1185 — Standards relating to benefits for mothers and newborns

**(a) Requirements for minimum hospital stay following birth** (1) **In general** — A group health plan, and a health insurance issuer offering group health insurance coverage, may not— (A) except as provided in paragraph (2)— (i) restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours, or (ii) restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a cesarean section, to less than 96 hours; or (B) require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under subparagraph (A) (without regard to paragraph (2)). (2) **Exception** — Paragraph (1)(A) shall not apply in connection with any group health plan or health insurance issuer in any case in which the decision to discharge the mother or her newborn child prior to the expiration of the minimum length of stay otherwise required under paragraph (1)(A) is made by an attending provider in consultation with the mother. **(b) Prohibitions** A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not— (1) deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; (2) provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section; (3) penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an ind

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1185

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Federal law — U.S. Code and appendices · legal_authorities

29 U.S.C. § 1191a — Special rules relating to group health

Page 612 TITLE 29—LABOR § 1191a law of the United States applicable only to the District of Columbia shall be treated as a State law rather than a law of the United States. (2) State The term ‘‘State’’ includes a State, the Northern Mariana Islands, any political sub- divisions of a State or such Islands, or any agency or instrumentality of either. (Pub. L. 93–406, title I, § 731, formerly § 704, as added Pub. L. 104–191, title I, § 101(a), Aug. 21, 1996, 110 Stat. 1946; renumbered § 731 and amend- ed Pub. L. 104–204, title VI, § 603(a)(3), (b)(1), Sept. 26, 1996, 110 Stat. 2935, 2937.) Editorial Notes AMENDMENTS 1996—Subsec. (c). Pub. L. 104–204, § 603(b)(1), sub- stituted ‘‘Except as provided in section 1185 of this title, nothing’’ for ‘‘Nothing’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1996 AMENDMENT Amendment by Pub. L. 104–204 applicable with re- spect to group health plans for plan years beginning on and after Jan. 1, 1998, see section 603(c) of Pub. L. 104–204, set out as a note under section 1003 of this title. EFFECTIVE DATE Section applicable with respect to group health plans for plan years beginning after June 30, 1997, except as otherwise provided, see section 101(g) of Pub. L. 104–191, set out as a note under section 1181 of this title. § 1191a. Special rules relating to group health plans (a) General exception for certain small group health plans The requirements of this part (other than sec- tion 1185 of this title) shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of such plan year, such plan has less than 2 par- ticipants who are current employees. (b) Exception for certain benefits T

Source: Supplied 2024 U.S. Code historical extraction · 29 U.S.C. § 1191a

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