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26 U.S.C. § 9803 — Guaranteed renewability in multiemployer plans and certain multiple employer welfare arrangements
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** A group health plan which is a multiemployer plan (as defined in section 414(f)) or which is a multiple employer welfare arrangement may not deny an employer continued access to the same or different coverage under such plan, other than—
(1) for nonpayment of contributions;
(2) for fraud or other intentional misrepresentation of material fact by the employer;
(3) for noncompliance with material plan provisions;
(4) because the plan is ceasing to offer any coverage in a geographic area;
(5) in the case of a plan that offers benefits through a network plan, because there is no longer any individual enrolled through the employer who lives, resides, or works in the service area of the network plan and the plan applies this paragraph uniformly without regard to the claims experience of employers or a factor described in section 9802(a)(1) in relation to such individuals or their dependents; or
(6) for failure to meet the terms of an applicable collective bargaining agreement, to renew a collective bargaining or other agreement requiring or authorizing contributions to the plan, or to employ employees covered by such an agreement.
**(b) Multiple employer welfare arrangement** For purposes of subsection (a), the term “multiple employer welfare arrangement” has the meaning given such term by section 3(40) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section.
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Source file: Laws/federal/codes/united-states-code/title-26/section-9803-guaranteed-renewability-in-multiemployer-plans-and-certain-multiple-empl--f5ba8bcd4f.md
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Source location: Title 26, Chapter 100, § 9803; chapter-100-group-health-plan-requirements.md
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**(a) In general** A group health plan which is a multiemployer plan (as defined in section 414(f)) or which is a multiple employer welfare arrangement may not deny an employer continued access to the same or different coverage under such plan, other than—
(1) for nonpayment of contributions;
(2) for fraud or other intentional misrepresentation of material fact by the employer;
(3) for noncompliance with material plan provisions;
(4) because the plan is ceasing to offer any coverage in a geographic area;
(5) in the case of a plan that offers benefits through a network plan, because there is no longer any individual enrolled through the employer who lives, resides, or works in the service area of the network plan and the plan applies this paragraph uniformly without regard to the claims experience of employers or a factor described in section 9802(a)(1) in relation to such individuals or their dependents; or
(6) for failure to meet the terms of an applicable collective bargaining agreement, to renew a collective bargaining or other agreement requiring or authorizing contributions to the plan, or to employ employees covered by such an agreement.
**(b) Multiple employer welfare arrangement** For purposes of subsection (a), the term “multiple employer welfare arrangement” has the meaning given such term by section 3(40) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section.
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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 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
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Federal law — U.S. Code and appendices · legal_authorities
Page 4179
TITLE 26—INTERNAL REVENUE CODE
§ 9803
quirements of this section solely because such
plan requires evidence of good health for cov-
erage of—
(1) both any employee of an employer with 10
or less employees (determined without regard
to section 414(e)(3)(C)) and any self-employed
individual, or
(2) any individual who enrolls after the first
90 days of initial eligibility under the plan.
This subsection shall apply to a plan for any
year only if the plan included the provisions de-
scribed in the preceding sentence on July 15,
1997, and at all times thereafter before the be-
ginning of such year.
(g) Genetic information of a fetus or embryo
Any reference in this chapter to genetic infor-
mation concerning an individual or family mem-
ber of an individual shall—
(1) with respect to such an individual or fam-
ily 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.
(Added Pub. L. 104–191, title IV, § 401(a), Aug. 21,
1996, 110 Stat. 2078; amended Pub. L. 105–34, title
XV, § 1532(a), Aug. 5, 1997, 111 Stat. 1085; Pub. L.
110–233, title I, § 103(a)–(c), May 21, 2008, 122 Stat.
896, 897; Pub. L. 113–295, div. A, title II, § 220(aa),
Dec. 19, 2014, 128 Stat. 4037.)
Editorial Notes
REFERENCES IN TEXT
The Social Security Act, referred to in subsec.
(c)(3)(A), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part
C of title XI of the Act is classified generally to part
C (§ 1320d et seq.) of subchapter XI of chapter 7 of Title
42, The Public Health and Welfare. For complete classi-
fication
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