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42 U.S.C. § 300gg–21 — Exclusion of certain plans
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
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Stable record: federal_law:legal_authorities:record_usc_ba650e58e5c423d92ad73914
Source file: Laws/federal/codes/united-states-code/title-42/section-300gg21-exclusion-of-certain-plans--fb7ea04b19.md
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Source location: Title 42, Chapter 6A, § 300gg–21; chapter-6a-public-health-service.md
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**(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 respect to enrollees in accordance with section 2701(e).1
(D) *Election not applicable to requirements concerning genetic information* — The election described in subparagraph (A) shall not be available with respect to the provisions of subsections (a)(1)(F), (b)(3), (c), and (d) of section 2702 1 and the provisions of sections 2701 1 and 2702(b) 1 to the extent that such provisions apply to genetic information.
(E) *Election not applicable* — The election described in subparagraph (A) shall not be available with respect to the provisions of subparts I and II.
(F) *Sunset of election option*
(i) *In general* — Notwithstanding the preceding provisions of this paragraph—
(I) no election described in subparagraph (A) with respect to [section 300gg–26 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-26&num=0&edition=prelim) may be made on or after December 29, 2022; and
(II) except as provided in clause (ii), no such election with respect to [section 300gg–26 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-26&num=0&edition=prelim) expiring on or after the date that is 180 days after December 29, 2022, may be renewed.
(ii) *Exception for certain collectively bargained plans* — Notwithstanding clause (i)(II), a plan described in subparagraph (B)(ii) that is subject to multiple agreements described in such subparagraph of varying lengths and that has an election described in subparagraph (A) with respect to [section 300gg–26 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg-26&num=0&edition=prelim) in effect as of December 29, 2022, that expires on or after the date that is 180 days after December 29, 2022, may extend such election until the date on which the term of the last such agreement expires.
**(b) Exception for certain benefits** The requirements of subparts 1 and 2 1 and part D shall not apply to any individual coverage or any group health plan (or group health insurance coverage) in relation to its provision of excepted benefits described in [section 300gg–91(c)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–91/c/1&num=0&edition=prelim).
**(c) Exception for certain benefits if certain conditions met**
(1) **Limited, excepted benefits** — The requirements of subparts 1 and 2 1 and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in [section 300gg–91(c)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–91/c/2&num=0&edition=prelim) if the benefits—
(A) are provided under a separate policy, certificate, or contract of insurance; or
(B) are otherwise not an integral part of the plan.
(2) **Noncoordinated, excepted benefits** — The requirements of subparts 1 and 2 1 and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in [section 300gg–91(c)(3) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–91/c/3&num=0&edition=prelim) if all of the following conditions are met:
(A) The benefits are provided under a separate policy, certificate, or contract of insurance.
(B) There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor.
(C) Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer.
(3) **Supplemental excepted benefits** — The requirements of this part and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in section 300gg–91(c)(4) 1 of this title if the benefits are provided under a separate policy, certificate, or contract of insurance.
**(d) Treatment of partnerships** For purposes of this part and part D—
(1) **Treatment as a group health plan** — Any plan, fund, or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or program provides medical care (including items and services paid for as medical care) to present or former partners in the partnership or to their dependents (as defined under the terms of the plan, fund, or program), directly or through insurance, reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare benefit plan which is a group health plan.
(2) **Employer** — In the case of a group health plan, the term “employer” also includes the partnership in relation to any partner.
(3) **Participants of group health plans** — In the case of a group health plan, the term “participant” also includes—
(A) in connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership, or
(B) in connection with a group health plan maintained by a self-employed individual (under which one or more employees are participants), the self-employed individual,
if such individual is, or may become, eligible to receive a benefit under the plan or such individual’s beneficiaries may be eligible to receive any such benefit.
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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.
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 9834
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Federal law — U.S. Code and appendices · legal_authorities
**(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
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg
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Federal law — U.S. Code and appendices · legal_authorities
**(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
Source: Supplied U.S. Code snapshot — release unconfirmed · 5 U.S.C. § 8902
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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 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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