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42 U.S.C. § 18011 — Preservation of right to maintain existing coverage

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

42 U.S.C. § 18011 — Preservation of right to maintain existing coverage

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Source file: Laws/federal/codes/united-states-code/title-42/section-18011-preservation-of-right-to-maintain-existing-coverage--4f3a402460.md
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Source location: Title 42, Chapter 157, § 18011; chapter-157-quality-affordable-health-care-for-all-americans.md

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**(a) No changes to existing coverage** (1) **In general** — Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on March 23, 2010. (2) **Continuation of coverage** — Except as provided in paragraph (3), with respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after March 23, 2010. (3) **Application of certain provisions** — The provisions of sections 2715 [[42 U.S.C. 300gg–15](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-15&num=0&edition=prelim)] and 2718 [[42 U.S.C. 300gg–18](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-18&num=0&edition=prelim)] of the Public Health Service Act (as added by subtitle A) shall apply to grandfathered health plans for plan years beginning on or after March 23, 2010. (4) **Application of certain provisions** (A) *In general* — The following provisions of the Public Health Service Act [[42 U.S.C. 201](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section201&num=0&edition=prelim) et seq.] (as added by this title) 11 See References in Text note below. shall apply to grandfathered health plans for plan years beginning with the first plan year to which such provisions would otherwise apply: (i) Section 2708 [[42 U.S.C. 300gg–7](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-7&num=0&edition=prelim)] (relating to excessive waiting periods). (ii) Those provisions of section 2711 [[42 U.S.C. 300gg–11](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-11&num=0&edition=prelim)] relating to lifetime limits. (iii) Section 2712 [[42 U.S.C. 300gg–12](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-12&num=0&edition=prelim)] (relating to rescissions). (iv) Section 2714 [[42 U.S.C. 300gg–14](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-14&num=0&edition=prelim)] (relating to extension of dependent coverage). (B) *Provisions applicable only to group health plans* (i) *Provisions described* — Those provisions of section 2711 [[42 U.S.C. 300gg–11](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-11&num=0&edition=prelim)] relating to annual limits and the provisions of section 2704 [[42 U.S.C. 300gg–3](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-3&num=0&edition=prelim)] (relating to pre-existing condition exclusions) of the Public Health Service Act (as added by this subtitle) shall apply to grandfathered health plans that are group health plans for plan years beginning with the first plan year to which such provisions otherwise apply. (ii) *Adult child coverage* — For plan years beginning before January 1, 2014, the provisions of section 2714 of the Public Health Service Act [[42 U.S.C. 300gg–14](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-14&num=0&edition=prelim)] (as added by this subtitle) shall apply in the case of an adult child with respect to a grandfathered health plan that is a group health plan only if such adult child is not eligible to enroll in an eligible employer-sponsored health plan (as defined in [section 5000A(f)(2) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section5000A/f/2&num=0&edition=prelim)) other than such grandfathered health plan. (5) **Application of additional provisions** — Sections 300gg–111, 300gg–112, and 300gg–117 of this title shall apply to grandfathered health plans for plan years beginning on or after January 1, 2022. **(b) Allowance for family members to join current coverage** With respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of March 23, 2010. **(c) Allowance for new employees to join current plan** A group health plan that provides coverage on March 23, 2010, may provide for the enrolling of new employees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their families). **(d) Effect on collective bargaining agreements** In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before March 23, 2010, the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to conform to any requirement added by this subtitle or subtitle A (or amendments) shall not be treated as a termination of such collective bargaining agreement. **(e) Definition** In this title,1 the term “grandfathered health plan” means any group health plan or health insurance coverage to which this section applies.

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

42 U.S.C. § 18001 — Immediate access to insurance for uninsured individuals with a preexisting condition

**(a) In general** Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014. **(b) Administration** (1) **In general** — The Secretary may carry out the program under this section directly or through contracts to eligible entities. (2) **Eligible entities** — To be eligible for a contract under paragraph (1), an entity shall— (A) be a State or nonprofit private entity; (B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and (C) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals. (3) **Maintenance of effort** — To be eligible to enter into a contract with the Secretary under this subsection, a State shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools during the year preceding the year in which such contract is entered into. **(c) Qualified high risk pool** (1) **In general** — Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2). (2) **Requirements** — A qualified high risk pool meets the requirements of this paragraph if such pool— (A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage; (B) provides health insurance coverage— (i) in which the issuer’s share of the total allowed costs of benefits provided under such co

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

42 U.S.C. § 201 — Funding

Beginning with fiscal year 2010, the Secretary shall transfer from the Public Health and Social Services Emergency Fund such sums as may be necessary to carry out this part.

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

42 U.S.C. § 300gg — Fair health insurance premiums

**(a) 11 So in original. No subsec. (b) has been enacted. Prohibiting discriminatory premium rates** (1) **In general** — With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market— (A) such rate shall vary with respect to the particular plan or coverage involved only by— (i) whether such plan or coverage covers an individual or family; (ii) rating area, as established in accordance with paragraph (2); (iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with [section 300gg–6(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–6/c&num=0&edition=prelim)); and (iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and (B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A). (2) **Rating area** (A) *In general* — Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter. (B) *Secretarial review* — The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this subchapter. If the Secretary determines a State’s rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State. (3) **Permissible age bands** — The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii). (4) **Application of variat

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

5 U.S.C. § 8902 — Contracting authority

**(a)** The Office of Personnel Management may contract with qualified carriers offering plans described by section 8903 or 8903a of this title, without regard to section 6101(b) to (d) of title 41 or other statute requiring competitive bidding. Each contract shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. **(b)** To be eligible as a carrier for the plan described by [section 8903(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8903/2&num=0&edition=prelim), a company must be licensed to issue group health insurance in all the States and the District of Columbia. **(c)** A contract for a plan described by section 8903(1) or (2) of this title shall require the carrier— (1) to reinsure with other companies which elect to participate, under an equitable formula based on the total amount of their group health insurance benefit payments in the United States during the latest year for which the information is available, to be determined by the carrier and approved by the Office; or (2) to allocate its rights and obligations under the contract among its affiliates which elect to participate, under an equitable formula to be determined by the carrier and the affiliates and approved by the Office. **(d)** Each contract under this chapter shall contain a detailed statement of benefits offered and shall include such maximums, limitations, exclusions, and other definitions of benefits as the Office considers necessary or desirable. **(e)** The Office may prescribe reasonable minimum standards for health benefits plans described by section 8903 or 8903a of this title and for carriers offering the plans. Approval of a pla

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

42 U.S.C. § 18011 — Preservation of right to maintain exist-

Page 9092 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 18011 1 See References in Text note below. ‘‘(E) Coverage under a high risk pool under section 18001 of this title.’’ SUBCHAPTER II—OTHER PROVISIONS § 18011. Preservation of right to maintain exist- ing coverage (a) No changes to existing coverage (1) In general Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance cov- erage in which such individual was enrolled on March 23, 2010. (2) Continuation of coverage Except as provided in paragraph (3), with re- spect to a group health plan or health insur- ance coverage in which an individual was en- rolled on March 23, 2010, this subtitle and sub- title A (and the amendments made by such subtitles) shall not apply to such plan or cov- erage, regardless of whether the individual re- news such coverage after March 23, 2010. (3) Application of certain provisions The provisions of sections 2715 [42 U.S.C. 300gg–15] and 2718 [42 U.S.C. 300gg–18] of the Public Health Service Act (as added by sub- title A) shall apply to grandfathered health plans for plan years beginning on or after March 23, 2010. (4) Application of certain provisions (A) In general The following provisions of the Public Health Service Act [42 U.S.C. 201 et seq.] (as added by this title) 1 shall apply to grand- fathered health plans for plan years begin- ning with the first plan year to which such provisions would otherwise apply: (i) Section 2708 [42 U.S.C. 300gg–7] (relat- ing to excessive waiting periods). (ii) Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to lifetime limits. (iii) Section 2712 [42 U.S.C. 300gg–12] (re- lating to rescissions). (iv) Se

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

42 U.S.C. § 201 — Definitions

Page 35 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 201 1 See References in Text note below. Sec. 300jj–34. Competitive grants to States and Indian tribes for the development of loan pro- grams to facilitate the widespread adoption of certified EHR technology. 300jj–35. Demonstration program to integrate in- formation technology into clinical education. 300jj–36. Information technology professionals in health care. 300jj–37. General grant and loan provisions. 300jj–38. Authorization for appropriations. PART C—OTHER PROVISIONS 300jj–51. Health information technology enroll- ment standards and protocols. 300jj–52. Information blocking. SUBCHAPTER XXIX—DATA COLLECTION, ANALYSIS, AND QUALITY 300kk. Data collection, analysis, and quality. SUBCHAPTER XXX—COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS 300ll to 300ll–9. Repealed. SUBCHAPTER XXXI—WORLD TRADE CENTER HEALTH PROGRAM PART A—ESTABLISHMENT OF PROGRAM; ADVISORY COMMITTEE 300mm. Establishment of World Trade Center Health Program. 300mm–1. WTC Health Program Scientific/Tech- nical Advisory Committee; WTC Health Program Steering Committees. 300mm–2. Education and outreach. 300mm–3. Uniform data collection and analysis. 300mm–4. Clinical Centers of Excellence and Data Centers. 300mm–5. Definitions. PART B—PROGRAM OF MONITORING, INITIAL HEALTH EVALUATIONS, AND TREATMENT SUBPART 1—WTC RESPONDERS 300mm–21. Identification of WTC responders and provision of WTC-related monitoring services. 300mm–22. Treatment of enrolled WTC responders for WTC-related health conditions. 300mm–23. National arrangement for benefits for el- igible individuals outside New York. SUBPART 2—WTC SURVIVORS 300mm–31. Identification and initial health evalua- tion of screening-eligible and

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

42 U.S.C. § 300gg — Fair health insurance premiums

Page 1597 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 300gg 1 So in original. 1 So in original. No subsec. (b) has been enacted. require the provision of data to public health authorities. (July 1, 1944, ch. 373, title XXVI, § 2695G, as added Pub. L. 111–87, § 13, Oct. 30, 2009, 123 Stat. 2902.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section effective as if enacted on Sept. 30, 2009, see section 2(a)(3)(B) of Pub. L. 111–87, set out as an Effec- tive Date of 2009 Amendment; Revival of Section note under section 300ff–11 of this title. § 300ff–139. Injunctions regarding violation of prohibition (a) In general The Secretary may, in any court of competent jurisdiction, commence a civil action for the purpose of obtaining temporary or permanent injunctive relief with respect to any violation of this part. (b) Facilitation of information on violations The Secretary shall establish an administra- tive process for encouraging emergency response employees to provide information to the Sec- retary regarding violations of this part. As ap- propriate, the Secretary shall investigate al- leged such 1 violations and seek appropriate in- junctive relief. (July 1, 1944, ch. 373, title XXVI, § 2695H, as added Pub. L. 111–87, § 13, Oct. 30, 2009, 123 Stat. 2902.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section effective as if enacted on Sept. 30, 2009, see section 2(a)(3)(B) of Pub. L. 111–87, set out as an Effec- tive Date of 2009 Amendment; Revival of Section note under section 300ff–11 of this title. § 300ff–140. Applicability of part This part shall not apply in a State if the chief executive officer of the State certifies to the Secretary that the law of the State is substan- tially consistent with this part. (July 1, 19

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 300gg

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