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29 U.S.C. § 1182 — Prohibiting discrimination against individual participants and beneficiaries based on health status
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, and a health insurance issuer offering group health insurance coverage in connection with 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 health status-related 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 1181 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1181&num=0&edition=prelim), paragraph (1) shall not be construed—
(A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or
(B) to prevent such a plan or coverage 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, and a health insurance issuer offering health insurance coverage in connection with a group health plan, m
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Source file: Laws/federal/codes/united-states-code/title-29/section-1182-prohibiting-discrimination-against-individual-participants-and-beneficia--878bd9b327.md
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Source location: Title 29, Chapter 18, § 1182; chapter-018-employee-retirement-income-security-program.md
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**(a) In eligibility to enroll**
(1) **In general** — Subject to paragraph (2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with 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 health status-related 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 1181 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1181&num=0&edition=prelim), paragraph (1) shall not be construed—
(A) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage, or
(B) to prevent such a plan or coverage 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, and a health insurance issuer offering health insurance coverage in connection with 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 health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.
(2) **Construction** — Nothing in paragraph (1) shall be construed—
(A) to restrict the amount that an employer may be charged for coverage under a group health plan except as provided in paragraph (3); or
(B) to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
(3) **No group-based discrimination on basis of genetic information**
(A) *In general* — For purposes of this section, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not adjust premium or contribution amounts for the group covered under such plan on the basis of genetic information.
(B) *Rule of construction* — Nothing in subparagraph (A) or in paragraphs (1) and (2) of subsection (d) shall be construed to limit the ability of a health insurance issuer offering health insurance coverage in connection with a group health plan to increase the premium for an employer based on the manifestation of a disease or disorder of an individual who is enrolled in the plan. In such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the employer.
**(c) Genetic testing**
(1) **Limitation on requesting or requiring genetic testing** — A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request or require an individual or a family member of such individual to undergo a genetic test.
(2) **Rule of construction** — Paragraph (1) shall not be construed to limit the authority of a health care professional who is providing health care services to an individual to request that such individual undergo a genetic test.
(3) **Rule of construction regarding payment**
(A) *In general* — Nothing in paragraph (1) shall be construed to preclude a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, from obtaining and using the results of a genetic test in making a determination regarding payment (as such term is defined for the purposes of applying the regulations promulgated by the Secretary of Health and Human Services under part C of title XI of the Social Security Act [[42 U.S.C. 1320d](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1320d&num=0&edition=prelim) et seq.] and section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time) consistent with subsection (a).
(B) *Limitation* — For purposes of subparagraph (A), a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, may request only the minimum amount of information necessary to accomplish the intended purpose.
(4) **Research exception** — Notwithstanding paragraph (1), a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, may request, but not require, that a participant or beneficiary undergo a genetic test if each of the following conditions is met:
(A) The request is made, in writing, pursuant to research that complies with part 46 of title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable State or local law or regulations for the protection of human subjects in research.
(B) The plan or issuer clearly indicates to each participant or beneficiary, or in the case of a minor child, to the legal guardian of such beneficiary, to whom the request is made that—
(i) compliance with the request is voluntary; and
(ii) non-compliance will have no effect on enrollment status or premium or contribution amounts.
(C) No genetic information collected or acquired under this paragraph shall be used for underwriting purposes.
(D) The plan or issuer notifies the Secretary in writing that the plan or issuer is conducting activities pursuant to the exception provided for under this paragraph, including a description of the activities conducted.
(E) The plan or issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this paragraph.
**(d) Prohibition on collection of genetic information**
(1) **In general** — A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request, require, or purchase genetic information for underwriting purposes (as defined in [section 1191b of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191b&num=0&edition=prelim)).
(2) **Prohibition on collection of genetic information prior to enrollment** — A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, shall not request, require, or purchase genetic information with respect to any individual prior to such individual’s enrollment under the plan or coverage in connection with such enrollment.
(3) **Incidental collection** — If a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of paragraph (2) if such request, requirement, or purchase is not in violation of paragraph (1).
**(e) Application to all plans** The provisions of subsections (a)(1)(F), (b)(3), (c), and (d), and subsection (b)(1) and [section 1181 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1181&num=0&edition=prelim) with respect to genetic information, shall apply to group health plans and health insurance issuers without regard to [section 1191a(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1191a/a&num=0&edition=prelim).
**(f) Genetic information of a fetus or embryo** Any reference in this part to genetic information concerning an individual or family member of an individual shall—
(1) with respect to such an individual or family member of an individual who is a pregnant woman, include genetic information of any fetus carried by such pregnant woman; and
(2) with respect to an individual or family member utilizing an assisted reproductive technology, include genetic information of any embryo legally held by the individual or family member.
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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
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
**(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) Standards to enable electronic exchange**
(1) **In general** — The Secretary shall adopt standards for transactions, and data elements for such transactions, to enable health information to be exchanged electronically, that are appropriate for—
(A) the financial and administrative transactions described in paragraph (2); and
(B) other financial and administrative transactions determined appropriate by the Secretary, consistent with the goals of improving the operation of the health care system and reducing administrative costs, and subject to the requirements under paragraph (5).
(2) **Transactions** — The transactions referred to in paragraph (1)(A) are transactions with respect to the following:
(A) Health claims or equivalent encounter information.
(B) Health claims attachments.
(C) Enrollment and disenrollment in a health plan.
(D) Eligibility for a health plan.
(E) Health care payment and remittance advice.
(F) Health plan premium payments.
(G) First report of injury.
(H) Health claim status.
(I) Referral certification and authorization.
(J) Electronic funds transfers.
(3) **Accommodation of specific providers** — The standards adopted by the Secretary under paragraph (1) shall accommodate the needs of different types of health care providers.
(4) **Requirements for financial and administrative transactions**
(A) *In general* — The standards and associated operating rules adopted by the Secretary shall—
(i) to the extent feasible and appropriate, enable determination of an individual’s eligibility and financial responsibility for specific services prior to or at the point of care;
(ii) be comprehensive, requiring minimal augmentation by paper or other communications;
(iii) provide for timely acknowledg
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Federal law — U.S. Code and appendices · legal_authorities
This chapter may be cited as the “Social Security Act”.
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Federal law — U.S. Code and appendices · legal_authorities
For purposes of this part:
(1) **Code set** — The term “code set” means any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.
(2) **Health care clearinghouse** — The term “health care clearinghouse” means a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements.
(3) **Health care provider** — The term “health care provider” includes a provider of services (as defined in [section 1395x(u) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/u&num=0&edition=prelim)), a provider of medical or other health services (as defined in [section 1395x(s) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1395x/s&num=0&edition=prelim)), and any other person furnishing health care services or supplies.
(4) **Health information** — The term “health information” means any information, whether oral or recorded in any form or medium, that—
(A) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and
(B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.
(5) **Health plan** — The term “health plan” means an individual or group plan that provides, or pays the cost of, medical care (as such term is defined in [section 300gg–91 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-9
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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
Page 578
TITLE 29—LABOR
§ 1182
coordination disclosure form developed under subpara-
graph (C) [set out above] shall apply with respect to re-
quests made by States beginning with the first plan
year that begins after the date on which such model
coverage coordination disclosure form is first issued.’’
§ 1182. Prohibiting discrimination against indi-
vidual participants and beneficiaries based
on health status
(a) In eligibility to enroll
(1) In general
Subject to paragraph (2), a group health
plan, and a health insurance issuer offering
group health insurance coverage in connection
with a group health plan, may not establish
rules for eligibility (including continued eligi-
bility) of any individual to enroll under the
terms of the plan based on any of the fol-
lowing health status-related factors in rela-
tion to the individual or a dependent of the in-
dividual:
(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 vi-
olence).
(H) Disability.
(2) No application to benefits or exclusions
To the extent consistent with section 1181 of
this title, paragraph (1) shall not be con-
strued—
(A) to require a group health plan, or
group health insurance coverage, to provide
particular benefits other than those pro-
vided under the terms of such plan or cov-
erage, or
(B) to prevent such a plan or coverage
from establishing limitations or restrictions
on the amount, level, extent, or nature of
the benefits or coverage for similarly situ-
ated individuals enrolled in the plan or cov-
erage.
(3) Construction
For purposes of paragraph (1
Source: Supplied 2024 U.S. Code historical extraction · 29 U.S.C. § 1182
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.
Federal law — U.S. Code and appendices · legal_authorities
Page 2746
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1320c–20
1 So in original. Probably should be ‘‘Part’’.
tions between Professional Standards Review Organiza-
tions and administrative instrumentalities.
Section 1320c–15, act Aug. 14, 1935, ch. 531, title XI,
§ 1166, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1443; amended Oct. 25, 1977, Pub. L.
95–142, § 5(h), 91 Stat. 1189, related to general prohibi-
tion against disclosure of data or information and ex-
ceptions to such prohibition. See section 1320c–9 of this
title.
Section 1320c–16, act Aug. 14, 1935, ch. 531, title XI,
§ 1167, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1443; amended Oct. 25, 1977, Pub. L.
95–142, § 5(i), (n), 91 Stat. 1190, 1191, related to limitation
of liability of persons providing information to Profes-
sional Standards Review Organizations and Statewide
Professional Standards Review Councils. See section
1320c–6 of this title.
Section 1320c–17, act Aug. 14, 1935, ch. 531, title XI,
§ 1168, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1444; amended Dec. 31, 1975, Pub. L.
94–182, title I, § 112(c), 89 Stat. 1055; Oct. 25, 1977, Pub. L.
95–142, § 5(j), 91 Stat. 1190; Aug. 13, 1981, Pub. L. 97–35,
title XXI, § 2113(j), 95 Stat. 795, related to authorization
for use of funds for administering professional review
program, transfer of moneys between funds, and pay-
ments for Professional Standards Review Organiza-
tions. See section 1320c–8 of this title.
Section 1320c–18, act Aug. 14, 1935, ch. 531, title XI,
§ 1169, as added Oct. 30, 1972, Pub. L. 92–603, title II,
§ 249F(b), 86 Stat. 1444, related to technical assistance
given to organizations desiring to be designated as Pro-
fessional Stand
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1320d
Stored review status: historical_2024_not_currentness_verified. The source passage cites 42 U.S.C. § 1320d. This identifies an authority to review, not proof of applicability.