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26 U.S.C. § 9834 — Enforcement
Federal law — U.S. Code and appendices · legal_authorities
For the imposition of tax on any failure of a group health plan to meet the requirements of this chapter, see section 4980D.
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Source location: Title 26, Chapter 100, § 9834; chapter-100-group-health-plan-requirements.md
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For the imposition of tax on any failure of a group health plan to meet the requirements of this chapter, see section 4980D.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In eligibility to enroll**
(1) **In general** — Subject to paragraph (2), a group health plan may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following factors in relation to the individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both physical and mental illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including conditions arising out of acts of domestic violence).
(H) Disability.
(2) **No application to benefits or exclusions** — To the extent consistent with section 9801, paragraph (1) shall not be construed—
(A) to require a group health plan to provide particular benefits (or benefits with respect to a specific procedure, treatment, or service) other than those provided under the terms of such plan; or
(B) to prevent such a plan from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.
(3) **Construction** — For purposes of paragraph (1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for such enrollment.
**(b) In premium contributions**
(1) **In general** — A group health plan may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any factor described in subsection (a)(1) in relation to the individual or to an individu
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 9802
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Federal law — U.S. Code and appendices · legal_authorities
In this chapter:
(1) **Commission** — The term “Commission” means the Equal Employment Opportunity Commission as created by [section 2000e–4 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2000e-4&num=0&edition=prelim).
(2) **Employee; employer; employment agency; labor organization; member**
(A) *In general* — The term “employee” means—
(i) an employee (including an applicant), as defined in [section 2000e(f) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2000e/f&num=0&edition=prelim);
(ii) a State employee (including an applicant) described in [section 2000e–16c(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2000e–16c/a&num=0&edition=prelim);
(iii) a covered employee (including an applicant), as defined in [section 1301 of title 2](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title2-section1301&num=0&edition=prelim);
(iv) a covered employee (including an applicant), as defined in [section 411(c) of title 3](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title3-section411/c&num=0&edition=prelim); or
(v) an employee or applicant to which [section 2000e–16(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2000e–16/a&num=0&edition=prelim) applies.
(B) *Employer* — The term “employer” means—
(i) an employer (as defined in [section 2000e(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2000e/b&num=0&edition=prelim));
(ii) an entity employing a State employee described in [section 2000e–16c(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Limitation on application of provisions relating to group health plans**
(1) **In general** — The requirements of subparts 1 and 2 11 See References in Text note below. and part D shall apply with respect to group health plans only—
(A) subject to paragraph (2), in the case of a plan that is a nonfederal governmental plan, and
(B) with respect to health insurance coverage offered in connection with a group health plan (including such a plan that is a church plan or a governmental plan).
(2) **Treatment of non-Federal governmental plans**
(A) *Election to be excluded* — Except as provided in subparagraph (D) or (E), if the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of subparts 1 and 2 1 otherwise apply makes an election under this subparagraph (in such form and manner as the Secretary may by regulations prescribe), then the requirements of such subparts insofar as they apply directly to group health plans (and not merely to group health insurance coverage) shall not apply to such governmental plans for such period except as provided in this paragraph.
(B) *Period of election* — An election under subparagraph (A) shall apply—
(i) for a single specified plan year, or
(ii) in the case of a plan provided pursuant to a collective bargaining agreement, for the term of such agreement.
An election under clause (i) may be extended through subsequent elections under this paragraph.
(C) *Notice to enrollees* — Under such an election, the plan shall provide for—
(i) notice to enrollees (on an annual basis and at the time of enrollment under the plan) of the fact and consequences of such election, and
(ii) certification and disclosure of creditable coverage under the plan with resp
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg–21
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Federal law — U.S. Code and appendices · legal_authorities
Page 4213
TITLE 26—INTERNAL REVENUE CODE
§ 9834
teins,
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 metabo-
lites that is directly related to a mani-
fested disease, disorder, or pathological
condition that could reasonably be de-
tected by a health care professional with
appropriate training and expertise in the
field of medicine involved.
(9) Genetic services
The term ‘‘genetic services’’ means—
(A) a genetic test;
(B) genetic counseling (including obtain-
ing, interpreting, or assessing genetic infor-
mation); or
(C) genetic education.
(10) Underwriting purposes
The term ‘‘underwriting purposes’’ means,
with respect to any group health plan, or
health insurance coverage offered in connec-
tion with a group health plan—
(A) rules for, or determination of, eligi-
bility (including enrollment and continued
eligibility) for benefits under the plan or
coverage;
(B) the computation of premium or con-
tribution amounts under the plan or cov-
erage;
(C) the application of any pre-existing con-
dition 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.
(Added Pub. L. 104–191, title IV, § 401(a), Aug. 21,
1996, 110 Stat. 2080, § 9805; renumbered § 9832, Pub.
L. 105–34, title XV, § 1531(a)(2), Aug. 5, 1997, 111
Stat. 1081; amended Pub. L. 110–233, title I,
§ 103(d), May 21, 2008, 122 Stat. 898.)
Editorial Notes
REFERENCES IN TEXT
The Employee Retirement Income Security Act of
1974, referred to in su
Source: Supplied 2024 U.S. Code historical extraction · 26 U.S.C. § 9834
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.