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

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

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.

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Stable record: federal_law:legal_authorities:record_usc_d7f1a485ba2403cfcb30effe
Source file: Laws/federal/codes/united-states-code/title-29/section-1185d-additional-market-reforms--a83871602e.md
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Source location: Title 29, Chapter 18, § 1185d; chapter-018-employee-retirement-income-security-program.md

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

42 U.S.C. § 300gg–16 — Prohibition on discrimination in favor of highly compensated individuals

**(a) In general** A group health plan (other than a self-insured plan) shall satisfy the requirements of [section 105(h)(2) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section105/h/2&num=0&edition=prelim) (relating to prohibition on discrimination in favor of highly compensated individuals). **(b) Rules and definitions** For purposes of this section— (1) **Certain rules to apply** — Rules similar to the rules contained in paragraphs (3), (4), and (8) of [section 105(h) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section105/h&num=0&edition=prelim) shall apply. (2) **Highly compensated individual** — The term “highly compensated individual” has the meaning given such term by [section 105(h)(5) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section105/h/5&num=0&edition=prelim).

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg–16

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

42 U.S.C. § 18001 — Immediate access to insurance for uninsured individuals with a preexisting condition

**(a) In general** Not later than 90 days after March 23, 2010, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014. **(b) Administration** (1) **In general** — The Secretary may carry out the program under this section directly or through contracts to eligible entities. (2) **Eligible entities** — To be eligible for a contract under paragraph (1), an entity shall— (A) be a State or nonprofit private entity; (B) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; and (C) agree to utilize contract funding to establish and administer a qualified high risk pool for eligible individuals. (3) **Maintenance of effort** — To be eligible to enter into a contract with the Secretary under this subsection, a State shall agree not to reduce the annual amount the State expended for the operation of one or more State high risk pools during the year preceding the year in which such contract is entered into. **(c) Qualified high risk pool** (1) **In general** — Amounts made available under this section shall be used to establish a qualified high risk pool that meets the requirements of paragraph (2). (2) **Requirements** — A qualified high risk pool meets the requirements of this paragraph if such pool— (A) provides to all eligible individuals health insurance coverage that does not impose any preexisting condition exclusion with respect to such coverage; (B) provides health insurance coverage— (i) in which the issuer’s share of the total allowed costs of benefits provided under such co

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18001

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

42 U.S.C. § 201 — Funding

Beginning with fiscal year 2010, the Secretary shall transfer from the Public Health and Social Services Emergency Fund such sums as may be necessary to carry out this part.

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 201

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

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

**(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

26 U.S.C. § 9816 — Preventing surprise medical bills

**(a) Coverage of emergency services** (1) **In general** — If a group health plan provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emergency department (as defined in paragraph (3)(D)), the plan shall cover emergency services (as defined in paragraph (3)(C))— (A) without the need for any prior authorization determination; (B) whether the health care provider furnishing such services is a participating provider or a participating emergency facility, as applicable, with respect to such services; (C) in a manner so that, if such services are provided to a participant or beneficiary by a nonparticipating provider or a nonparticipating emergency facility— (i) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from participating providers and participating emergency facilities with respect to such plan; (ii) the cost-sharing requirement is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility; (iii) such cost-sharing requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to the recognized amount (as defined in paragraph (3)(H)) for such services, plan, and year; (iv) the group health plan— (I) not later than 30 calendar days after the bill for such services is transmitted by such provider or facility, sends to the provid

Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 9816

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

29 U.S.C. § 1185e — Preventing surprise medical bills

**(a) Coverage of emergency services** (1) **In general** — If a group health plan, or a health insurance issuer offering group health insurance coverage, provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emergency department (as defined in paragraph (3)(D)), the plan or issuer shall cover emergency services (as defined in paragraph (3)(C))— (A) without the need for any prior authorization determination; (B) whether the health care provider furnishing such services is a participating provider or a participating emergency facility, as applicable, with respect to such services; (C) in a manner so that, if such services are provided to a participant or beneficiary by a nonparticipating provider or a nonparticipating emergency facility— (i) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from participating providers and participating emergency facilities with respect to such plan or coverage, respectively; (ii) the cost-sharing requirement is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility; (iii) such cost-sharing requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to the recognized amount (as defined in paragraph (3)(H)) for such services, plan or coverage, and year; (iv) the group health plan or health insurance i

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

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

42 U.S.C. § 18119 — Small business procurement

Part 19 of the Federal Acquisition Regulation, [section 644 of title 15](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section644&num=0&edition=prelim), and any other applicable laws or regulations establishing procurement requirements relating to small business concerns (as defined in [section 632 of title 15](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section632&num=0&edition=prelim)) may not be waived with respect to any contract awarded under any program or other authority under this Act or an amendment made by this Act.

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18119

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

42 U.S.C. § 300gg–111 — Preventing surprise medical bills

**(a) Coverage of emergency services** (1) **In general** — If a group health plan, or a health insurance issuer offering group or individual health insurance coverage, provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emergency department (as defined in paragraph (3)(D)), the plan or issuer shall cover emergency services (as defined in paragraph (3)(C))— (A) without the need for any prior authorization determination; (B) whether the health care provider furnishing such services is a participating provider or a participating emergency facility, as applicable, with respect to such services; (C) in a manner so that, if such services are provided to a participant, beneficiary, or enrollee by a nonparticipating provider or a nonparticipating emergency facility— (i) such services will be provided without imposing any requirement under the plan or coverage for prior authorization of services or any limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from participating providers and participating emergency facilities with respect to such plan or coverage, respectively; (ii) the cost-sharing requirement is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility; (iii) such cost-sharing requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to the recognized amount (as defined in paragraph (3)(H)) for such services, plan or coverage, and year; (iv) the gr

Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg–111

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

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

Page 590 TITLE 29—LABOR § 1185d ondary educational institution (as described in subsection (a)), immediately before the first day of the medically necessary leave of absence involved. (3) Certification by physician Paragraph (1) shall apply to a group health plan or health insurance coverage offered by an issuer in connection with such plan only if the plan or issuer of the coverage has received written certification by a treating physician of the dependent child which states that the child is suffering from a serious illness or in- jury and that the leave of absence (or other change of enrollment) described in subsection (a) is medically necessary. (c) Notice A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, shall in- clude, with any notice regarding a requirement for certification of student status for coverage under the plan or coverage, a description of the terms of this section for continued coverage dur- ing medically necessary leaves of absence. Such description shall be in language which is under- standable to the typical plan participant. (d) No change in benefits A dependent child whose benefits are contin- ued under this section shall be entitled to the same benefits as if (during the medically nec- essary leave of absence) the child continued to be a covered student at the institution of higher education and was not on a medically necessary leave of absence. (e) Continued application in case of changed cov- erage If— (1) a dependent child of a participant or ben- eficiary is in a period of coverage under a group health plan or health insurance cov- erage offered in connection with such a plan, pursuant to a medically necessary leave of ab- sence of th

Source: Supplied 2024 U.S. Code historical extraction · 29 U.S.C. § 1185d

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

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

Page 1597 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 300gg 1 So in original. 1 So in original. No subsec. (b) has been enacted. require the provision of data to public health authorities. (July 1, 1944, ch. 373, title XXVI, § 2695G, as added Pub. L. 111–87, § 13, Oct. 30, 2009, 123 Stat. 2902.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section effective as if enacted on Sept. 30, 2009, see section 2(a)(3)(B) of Pub. L. 111–87, set out as an Effec- tive Date of 2009 Amendment; Revival of Section note under section 300ff–11 of this title. § 300ff–139. Injunctions regarding violation of prohibition (a) In general The Secretary may, in any court of competent jurisdiction, commence a civil action for the purpose of obtaining temporary or permanent injunctive relief with respect to any violation of this part. (b) Facilitation of information on violations The Secretary shall establish an administra- tive process for encouraging emergency response employees to provide information to the Sec- retary regarding violations of this part. As ap- propriate, the Secretary shall investigate al- leged such 1 violations and seek appropriate in- junctive relief. (July 1, 1944, ch. 373, title XXVI, § 2695H, as added Pub. L. 111–87, § 13, Oct. 30, 2009, 123 Stat. 2902.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section effective as if enacted on Sept. 30, 2009, see section 2(a)(3)(B) of Pub. L. 111–87, set out as an Effec- tive Date of 2009 Amendment; Revival of Section note under section 300ff–11 of this title. § 300ff–140. Applicability of part This part shall not apply in a State if the chief executive officer of the State certifies to the Secretary that the law of the State is substan- tially consistent with this part. (July 1, 19

Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 300gg

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