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29 U.S.C. § 1191b — Definitions
Federal law — U.S. Code and appendices · legal_authorities
**(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
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Source location: Title 29, Chapter 18, § 1191b; chapter-018-employee-retirement-income-security-program.md
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**(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 organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of [section 1144(b)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1144/b/2&num=0&edition=prelim)). Such term does not include a group health plan.
(3) **Health maintenance organization** — The term “health maintenance organization” means—
(A) a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act ([42 U.S.C. 300e(a)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300e/a&num=0&edition=prelim))),
(B) an organization recognized under State law as a health maintenance organization, or
(C) a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization.
(4) **Group health insurance coverage** — The term “group health insurance coverage” means, in connection with a group health plan, health insurance coverage offered in connection with such plan.
**(c) Excepted benefits** For purposes of this part, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:
(1) **Benefits not subject to requirements**
(A) Coverage only for accident, or disability income insurance, or any combination thereof.
(B) Coverage issued as a supplement to liability insurance.
(C) Liability insurance, including general liability insurance and automobile liability insurance.
(D) Workers’ compensation or similar insurance.
(E) Automobile medical payment insurance.
(F) Credit-only insurance.
(G) Coverage for on-site medical clinics.
(H) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
(2) **Benefits not subject to requirements if offered separately**
(A) Limited scope dental or vision benefits.
(B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
(C) Such other similar, limited benefits as are specified in regulations.
(3) **Benefits not subject to requirements if offered as independent, noncoordinated benefits**
(A) Coverage only for a specified disease or illness.
(B) Hospital indemnity or other fixed indemnity insurance.
(4) **Benefits not subject to requirements if offered as separate insurance policy** — Medicare supplemental health insurance (as defined under [section 1395ss(g)(1) of title 42](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395ss/g/1&num=0&edition=prelim)), coverage supplemental to the coverage provided under chapter 55 of title 10, and similar supplemental coverage provided to coverage under a group health plan.
**(d) Other definitions** For purposes of this part—
(1) **COBRA continuation provision** — The term “COBRA continuation provision” means any of the following:
(A) Part 6 of this subtitle.
(B) [Section 4980B of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section4980B&num=0&edition=prelim), other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines.
(C) Title XXII of the Public Health Service Act [[42 U.S.C. 300bb–1](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300bb–1&num=0&edition=prelim) et seq.].
(2) **Health status-related factor** — The term “health status-related factor” means any of the factors described in [section 1182(a)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1182/a/1&num=0&edition=prelim).
(3) **Network plan** — The term “network plan” means health insurance coverage offered by a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, in whole or in part, through a defined set of providers under contract with the issuer.
(4) **Placed for adoption** — The term “placement”, or being “placed”, for adoption, has the meaning given such term in [section 1169(c)(3)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1169/c/3/B&num=0&edition=prelim).
(5) **Family member** — The term “family member” means, with respect to an individual—
(A) a dependent (as such term is used for purposes of [section 1181(f)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1181/f/2&num=0&edition=prelim)) of such individual, and
(B) any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual or of an individual described in subparagraph (A).
(6) **Genetic information**
(A) *In general* — The term “genetic information” means, with respect to any individual, information about—
(i) such individual’s genetic tests,
(ii) the genetic tests of family members of such individual, and
(iii) the manifestation of a disease or disorder in family members of such individual.
(B) *Inclusion of genetic services and participation in genetic research* — Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.
(C) *Exclusions* — The term “genetic information” shall not include information about the sex or age of any individual.
(7) **Genetic test**
(A) *In general* — The term “genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.
(B) *Exceptions* — The term “genetic test” does not mean—
(i) an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or
(ii) an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.
(8) **Genetic services** — The term “genetic services” means—
(A) a genetic test;
(B) genetic counseling (including obtaining, interpreting, or assessing genetic information); or
(C) genetic education.
(9) **Underwriting purposes** — The term “underwriting purposes” means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan—
(A) rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage;
(B) the computation of premium or contribution amounts under the plan or coverage;
(C) the application of any pre-existing condition exclusion under the plan or coverage; and
(D) other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
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Federal law — U.S. Code and appendices · legal_authorities
**(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
**(a) General rule** There is hereby imposed a tax on the failure of a group health plan to meet the requirements of subsection (f) with respect to any qualified beneficiary.
**(b) Amount of tax**
(1) **In general** — The amount of the tax imposed by subsection (a) on any failure with respect to a qualified beneficiary shall be $100 for each day in the noncompliance period with respect to such failure.
(2) **Noncompliance period** — For purposes of this section, the term “noncompliance period” means, with respect to any failure, the period—
(A) beginning on the date such failure first occurs, and
(B) ending on the earlier of—
(i) the date such failure is corrected, or
(ii) the date which is 6 months after the last day in the period applicable to the qualified beneficiary under subsection (f)(2)(B) (determined without regard to clause (iii) thereof).
If a person is liable for tax under subsection (e)(1)(B) by reason of subsection (e)(2)(B) with respect to any failure, the noncompliance period for such person with respect to such failure shall not begin before the 45th day after the written request described in subsection (e)(2)(B) is provided to such person.
(3) **Minimum tax for noncompliance period where failure discovered after notice of examination** — Notwithstanding paragraphs (1) and (2) of subsection (c)—
(A) *In general* — In the case of 1 or more failures with respect to a qualified beneficiary—
(i) which are not corrected before the date a notice of examination of income tax liability is sent to the employer, and
(ii) which occurred or continued during the period under examination,
the amount of tax imposed by subsection (a) by reason of such failures with respect to such beneficiary shall not be less than the lesser of $
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 4980B
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** In accordance with regulations which the Secretary shall prescribe, each group health plan that is maintained by any State that receives funds under this chapter, by any political subdivision of such a State, or by any agency or instrumentality of such a State or political subdivision, shall provide, in accordance with this subchapter, that each qualified beneficiary who would lose coverage under the plan as a result of a qualifying event is entitled, under the plan, to elect, within the election period, continuation coverage under the plan.
**(b) Exception for certain plans** Subsection (a) shall not apply to—
(1) any group health plan for any calendar year if all employers maintaining such plan normally employed fewer than 20 employees on a typical business day during the preceding calendar year, or
(2) any group health plan maintained for employees by the government of the District of Columbia or any territory or possession of the United States or any agency or instrumentality.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300bb–1
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Federal law — U.S. Code and appendices · legal_authorities
For purposes of this part—
(1) **Group health plan** — The term “group health plan” means an employee welfare benefit plan providing medical care (as defined in [section 213(d) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section213/d&num=0&edition=prelim)) to participants or beneficiaries directly or through insurance, reimbursement, or otherwise. Such term shall not include any plan substantially all of the coverage under which is for qualified long-term care services (as defined in [section 7702B(c) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section7702B/c&num=0&edition=prelim)). 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) **Covered employee** — The term “covered employee” means an individual who is (or was) provided coverage under a group health plan by virtue of the performance of services by the individual for 1 or more persons maintaining the plan (including as an employee defined in [section 401(c)(1) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section401/c/1&num=0&edition=prelim)).
(3) **Qualified beneficiary**
(A) *In general* — The term “qualified beneficiary” means, with respect to a covered employee under a group health plan, any other individual who, on the day before the qualifying event for that employee, is a beneficiary under the plan—
(i) as the spouse of the covered employee, or
(ii) as the dependent child of the employee.
Such term shall also include a child who is born to or placed for adoption with the covered em
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1167
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Federal law — U.S. Code and appendices · legal_authorities
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
**(a) Persons empowered to bring a civil action** A civil action may be brought—
(1) by a participant or beneficiary—
(A) for the relief provided for in subsection (c) of this section, or
(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;
(2) by the Secretary, or by a participant, beneficiary or fiduciary for appropriate relief under [section 1109 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1109&num=0&edition=prelim);
(3) by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan;
(4) by the Secretary, or by a participant, or beneficiary for appropriate relief in the case of a violation of section 1025(c) or 1032(a) of this title;
(5) except as otherwise provided in subsection (b), by the Secretary (A) to enjoin any act or practice which violates any provision of this subchapter, or (B) to obtain other appropriate equitable relief (i) to redress such violation or (ii) to enforce any provision of this subchapter;
(6) by the Secretary to collect any civil penalty under paragraph (2), (4), (5), (6), (7), (8), or (9) of subsection (c) or under subsection (i) or (l);
(7) by a State to enforce compliance with a qualified medical child support order (as defined in [section 1169(a)(2)(A) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1169/a/2/A&num=0&edition=prelim));
(8) by the Secretary, o
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1132
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Federal law — U.S. Code and appendices · legal_authorities
**(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
**(a) Summary plan description and information to be furnished to participants and beneficiaries** The administrator of each employee benefit plan shall cause to be furnished in accordance with [section 1024(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1024/b&num=0&edition=prelim) to each participant covered under the plan and to each beneficiary who is receiving benefits under the plan—
(1) a summary plan description described in section 1022(a)(1) 11 See References in Text note below. of this title; and
(2) the information described in subsection (f) and sections 1024(b)(3) and 1025(a) and (c) of this title.
**(b) Reports to be filed with Secretary of Labor** The administrator shall, in accordance with [section 1024(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1024/a&num=0&edition=prelim), file with the Secretary—
(1) the annual report containing the information required by [section 1023 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1023&num=0&edition=prelim); and
(2) terminal and supplementary reports as required by subsection (c) of this section.
**(c) Terminal and supplementary reports**
(1) Each administrator of an employee pension benefit plan which is winding up its affairs (without regard to the number of participants remaining in the plan) shall, in accordance with regulations prescribed by the Secretary, file such terminal reports as the Secretary may consider necessary. A copy of such report shall also be filed with the Pension Benefit Guaranty Corporation.
(2) The Secretary may require terminal reports to be filed with regard to any employee welfare benefit plan which is winding up its affairs in accordance w
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1021
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Federal law — U.S. Code and appendices · legal_authorities
**(a)** A summary plan description of any employee benefit plan shall be furnished to participants and beneficiaries as provided in [section 1024(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1024/b&num=0&edition=prelim). The summary plan description shall include the information described in subsection (b), shall be written in a manner calculated to be understood by the average plan participant, and shall be sufficiently accurate and comprehensive to reasonably apprise such participants and beneficiaries of their rights and obligations under the plan. A summary of any material modification in the terms of the plan and any change in the information required under subsection (b) shall be written in a manner calculated to be understood by the average plan participant and shall be furnished in accordance with [section 1024(b)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1024/b/1&num=0&edition=prelim).
**(b)** The summary plan description shall contain the following information: The name and type of administration of the plan; in the case of a group health plan (as defined in [section 1191b(a)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b/a/1&num=0&edition=prelim)), whether a health insurance issuer (as defined in [section 1191b(b)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b/b/2&num=0&edition=prelim)) is responsible for the financing or administration (including payment of claims) of the plan and (if so) the name and address of such issuer; the name and address of the person designated as agent for the service of legal process, if such person is not the administrator; t
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1022
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Filing of annual report with Secretary**
(1) The administrator of any employee benefit plan subject to this part shall file with the Secretary the annual report for a plan year within 210 days after the close of such year (or within such time as may be required by regulations promulgated by the Secretary in order to reduce duplicative filing). The Secretary shall make copies of such annual reports available for inspection in the public document room of the Department of Labor.
(2)
(A) With respect to annual reports required to be filed with the Secretary under this part, the Secretary may by regulation prescribe simplified annual reports for any pension plan that—
(i) covers fewer than 100 participants; or
(ii) is a plan described in [section 1060(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1060/a&num=0&edition=prelim) that covers fewer than 1,000 participants, but only if no single employer in the plan has 100 or more participants covered by the plan.
(B) Nothing contained in this paragraph shall preclude the Secretary from requiring any information or data from any such plan to which this part applies where he finds such data or information is necessary to carry out the purposes of this subchapter nor shall the Secretary be precluded from revoking provisions for simplified reports for any such plan if he finds it necessary to do so in order to carry out the objectives of this subchapter.
(3) The Secretary may by regulation exempt any welfare benefit plan from all or part of the reporting and disclosure requirements of this subchapter, or may provide for simplified reporting and disclosure if he finds that such requirements are inappropriate as applied to welfare benefit plans.
(4) The Secretar
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1024
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