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

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

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

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Stable record: federal_law:legal_authorities:record_usc_9444e1391cfcd2e6f8d0c80c
Source file: Laws/federal/codes/united-states-code/title-42/section-300gg-fair-health-insurance-premiums--22bec8b935.md
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Source location: Title 42, Chapter 6A, § 300gg; chapter-6a-public-health-service.md

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**(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 variations based on age or tobacco use** — With respect to family coverage under a group health plan or health insurance coverage, the rating variations permitted under clauses (iii) and (iv) of paragraph (1)(A) shall be applied based on the portion of the premium that is attributable to each family member covered under the plan or coverage. (5) **Special rule for large group market** — If a State permits health insurance issuers that offer coverage in the large group market in the State to offer such coverage through the State Exchange (as provided for under [section 18032(f)(2)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18032/f/2/B&num=0&edition=prelim)), the provisions of this subsection shall apply to all coverage offered in such market (other than self-insured group health plans offered in such market) in the State.

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

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

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18011

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

29 U.S.C. § 1001 — Congressional findings and declaration of policy

**(a) Benefit plans as affecting interstate commerce and the Federal taxing power** The Congress finds that the growth in size, scope, and numbers of employee benefit plans in recent years has been rapid and substantial; that the operational scope and economic impact of such plans is increasingly interstate; that the continued well-being and security of millions of employees and their dependents are directly affected by these plans; that they are affected with a national public interest; that they have become an important factor affecting the stability of employment and the successful development of industrial relations; that they have become an important factor in commerce because of the interstate character of their activities, and of the activities of their participants, and the employers, employee organizations, and other entities by which they are established or maintained; that a large volume of the activities of such plans are carried on by means of the mails and instrumentalities of interstate commerce; that owing to the lack of employee information and adequate safeguards concerning their operation, it is desirable in the interests of employees and their beneficiaries, and to provide for the general welfare and the free flow of commerce, that disclosure be made and safeguards be provided with respect to the establishment, operation, and administration of such plans; that they substantially affect the revenues of the United States because they are afforded preferential Federal tax treatment; that despite the enormous growth in such plans many employees with long years of employment are losing anticipated retirement benefits owing to the lack of vesting provisions in such plans; that owing to the inadequacy of current minimum standards, the soundness and stabilit

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1001

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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

42 U.S.C. § 238 — Health and Human Services Office on Women’s Health

**(a) Establishment of Office** There is established within the Office of the Secretary, an Office on Women’s Health (referred to in this section as the “Office”). The Office shall be headed by a Deputy Assistant Secretary for Women’s Health who may report to the Secretary. **(b) Duties** The Secretary, acting through the Office, with respect to the health concerns of women, shall— (1) establish short-range and long-range goals and objectives within the Department of Health and Human Services and, as relevant and appropriate, coordinate with other appropriate offices on activities within the Department that relate to disease prevention, health promotion, service delivery, research, and public and health care professional education, for issues of particular concern to women throughout their lifespan; 11 So in original. Probably should be “lifespans;”. (2) provide expert advice and consultation to the Secretary concerning scientific, legal, ethical, and policy issues relating to women’s health; (3) monitor the Department of Health and Human Services’ offices, agencies, and regional activities regarding women’s health and identify needs regarding the coordination of activities, including intramural and extramural multidisciplinary activities; (4) establish a Department of Health and Human Services Coordinating Committee on Women’s Health, which shall be chaired by the Deputy Assistant Secretary for Women’s Health and composed of senior level representatives from each of the agencies and offices of the Department of Health and Human Services; (5) establish a National Women’s Health Information Center to— (A) facilitate the exchange of information regarding matters relating to health information, health promotion, preventive health services, research advances, and e

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 238

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

26 U.S.C. § 9801 — 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 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 length of the aggregate of the periods of creditable coverage (if any) applicable to the participant or beneficiary as of the enrollment date. **(b) Definitions** For purposes of this section— (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* — For purposes of this section, 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, the date of enrollment of the individual in the plan or, if earlier, the first day of the waiting per

Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 9801

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

29 U.S.C. § 1162 — Continuation coverage

For purposes of [section 1161 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1161&num=0&edition=prelim), the term “continuation coverage” means coverage under the plan which meets the following requirements: (1) **Type of benefit coverage** — The coverage must consist of coverage which, as of the time the coverage is being provided, is identical to the coverage provided under the plan to similarly situated beneficiaries under the plan with respect to whom a qualifying event has not occurred. If coverage is modified under the plan for any group of similarly situated beneficiaries, such coverage shall also be modified in the same manner for all individuals who are qualified beneficiaries under the plan pursuant to this part in connection with such group. (2) **Period of coverage** — The coverage must extend for at least the period beginning on the date of the qualifying event and ending not earlier than the earliest of the following: (A) *Maximum required period* (i) *General rule for terminations and reduced hours* — In the case of a qualifying event described in [section 1163(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1163/2&num=0&edition=prelim), except as provided in clause (ii), the date which is 18 months after the date of the qualifying event. (ii) *Special rule for multiple qualifying events* — If a qualifying event (other than a qualifying event described in [section 1163(6) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1163/6&num=0&edition=prelim)) occurs during the 18 months after the date of a qualifying event described in [section 1163(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1162

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

29 U.S.C. § 1165 — Election

**(a) In general** For purposes of this part— (1) **Election period** — The term “election period” means the period which— (A) begins not later than the date on which coverage terminates under the plan by reason of a qualifying event, (B) is of at least 60 days’ duration, and (C) ends not earlier than 60 days after the later of— (i) the date described in subparagraph (A), or (ii) in the case of any qualified beneficiary who receives notice under section 1166(4) 11 See References in Text note below. of this title, the date of such notice. (2) **Effect of election on other beneficiaries** — Except as otherwise specified in an election, any election of continuation coverage by a qualified beneficiary described in subparagraph (A)(i) or (B) of [section 1167(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1167/3&num=0&edition=prelim) shall be deemed to include an election of continuation coverage on behalf of any other qualified beneficiary who would lose coverage under the plan by reason of the qualifying event. If there is a choice among types of coverage under the plan, each qualified beneficiary is entitled to make a separate selection among such types of coverage. **(b) Temporary extension of COBRA election period for certain individuals** (1) **In general** — In the case of a nonelecting TAA-eligible individual and notwithstanding subsection (a), such individual may elect continuation coverage under this part during the 60-day period that begins on the first day of the month in which the individual becomes a TAA-eligible individual, but only if such election is made not later than 6 months after the date of the TAA-related loss of coverage. (2) **Commencement of coverage; no reach-back** — Any contin

Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1165

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29 U.S.C. § 1185d — Additional market reforms

**(a) General rule** Except as provided in subsection (b)— (1) the provisions of part A of title XXVII of the Public Health Service Act [[42 U.S.C. 300gg](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg&num=0&edition=prelim) et seq.] (as amended by the Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subpart; and (2) to the extent that any provision of this part conflicts with a provision of such part A with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such part A shall apply. **(b) Exception** Notwithstanding subsection (a), the provisions of sections 2716 and 2718 of title XXVII of the Public Health Service Act [[42 U.S.C. 300gg–16](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–16&num=0&edition=prelim), 300gg–18] (as amended by the Patient Protection and Affordable Care Act) shall not apply with respect to self-insured group health plans, and the provisions of this part shall continue to apply to such plans as if such sections of the Public Health Service Act (as so amended) had not been enacted.

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

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42 U.S.C. § 1320b–5 — Authority to waive requirements during national emergencies

**(a) Purpose** The purpose of this section is to enable the Secretary to ensure to the maximum extent feasible, in any emergency area and during an emergency period (as defined in subsection (g)(1))— (1) that sufficient health care items and services are available to meet the needs of individuals in such area enrolled in the programs under subchapters XVIII, XIX, and XXI; and (2) that health care providers (as defined in subsection (g)(2)) that furnish such items and services in good faith, but that are unable to comply with one or more requirements described in subsection (b), may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse. **(b) Secretarial authority** To the extent necessary to accomplish the purpose specified in subsection (a), the Secretary is authorized, subject to the provisions of this section, to temporarily waive or modify the application of, with respect to health care items and services furnished by a health care provider (or classes of health care providers) in any emergency area (or portion of such an area) during any portion of an emergency period, the requirements of subchapters XVIII, XIX, or XXI, or any regulation thereunder (and the requirements of this subchapter other than this section, and regulations thereunder, insofar as they relate to such subchapters), pertaining to— (1) (A) conditions of participation or other certification requirements for an individual health care provider or types of providers, (B) program participation and similar requirements for an individual health care provider or types of providers, and (C) pre-approval requirements; (2) requirements that physicians and other health care professionals be licensed in the State

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1320b–5

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

42 U.S.C. § 1395ddd — Certification of medicare supplemental health insurance policies

**(a) Submission of policy by insurer** (1) The Secretary shall establish a procedure whereby medicare supplemental policies (as defined in subsection (g)(1)) may be certified by the Secretary as meeting minimum standards and requirements set forth in subsection (c). Such procedure shall provide an opportunity for any insurer to submit any such policy, and such additional data as the Secretary finds necessary, to the Secretary for his examination and for his certification thereof as meeting the standards and requirements set forth in subsection (c). Subject to subsections (k)(3), (m), and (n), such certification shall remain in effect if the insurer files a notarized statement with the Secretary no later than June 30 of each year stating that the policy continues to meet such standards and requirements and if the insurer submits such additional data as the Secretary finds necessary to independently verify the accuracy of such notarized statement. Where the Secretary determines such a policy meets (or continues to meet) such standards and requirements, he shall authorize the insurer to have printed on such policy (but only in accordance with such requirements and conditions as the Secretary may prescribe) an emblem which the Secretary shall cause to be designed for use as an indication that a policy has received the Secretary’s certification. The Secretary shall provide each State commissioner or superintendent of insurance with a list of all the policies which have received his certification. (2) No medicare supplemental policy may be issued in a State on or after the date specified in subsection (p)(1)(C) unless— (A) the State’s regulatory program under subsection (b)(1) provides for the application and enforcement of the standards and requirements set forth in su

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1395ddd

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