26 U.S.C. § 9803 — Untitled legal text

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 of this Act to the Code, see section 1305 of Title 42 and Tables. Section 264 of the Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (c)(3)(A), is section 264 of Pub. L. 104–191, which is set out as a note under section 1320d–2 of Title 42, The Pub- lic Health and Welfare. AMENDMENTS 2014—Subsecs. (f), (g). Pub. L. 113–295 redesignated subsec. (f) relating to genetic information of a fetus or embryo as (g). 2008—Subsec. (b)(2)(A). Pub. L. 110–233, § 103(a)(1), in- serted ‘‘except as provided in paragraph (3)’’ before semicolon. Subsec. (b)(3). Pub. L. 110–233, § 103(a)(2), added par. (3). Subsecs. (c) to (e). Pub. L. 110–233, § 103(b), added sub- secs. (c) to (e). Former subsec. (c) redesignated (f) relat- ing to special rules for church plans. Subsec. (f). Pub. L. 110–233, § 103(c), added subsec. (f) relating to genetic information of a fetus or embryo. Pub. L. 110–233, § 103(b), redesignated subsec. (c) as (f) relating to special rules for church plans. 1997—Subsec. (c). Pub. L. 105–34 added subsec. (c). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2008 AMENDMENT Pub. L. 110–233, title I, § 103(f)(2), May 21, 2008, 122 Stat. 899, provided that: ‘‘The amendments made by this section [enacting section 9834 of this title and amending this section and section 9832 of this title] shall apply with respect to group health plans for plan years beginning after the date that is 1 year after the date of the enactment of this Act [May 21, 2008].’’ EFFECTIVE DATE OF 1997 AMENDMENT Pub. L. 105–34, title XV, § 1532(b), Aug. 5, 1997, 111 Stat. 1085, provided that: ‘‘The amendments made by subsection (a) [amending this section] shall take effect as if included in the amendments made by section 401(a) of the Health Insurance Portability and Account- ability Act of 1996 [Pub. L. 104–191].’’ REGULATIONS Pub. L. 110–233, title I, § 103(f)(1), May 21, 2008, 122 Stat. 899, provided that: ‘‘The Secretary of the Treas- ury shall issue final regulations or other guidance not later than 12 months after the date of the enactment of this Act [May 21, 2008] to carry out the amendments made by this section [enacting section 9834 of this title and amending this section and section 9832 of this title].’’ EFFECTIVE DATE Section applicable to plan years beginning after June 30, 1997, see section 401(c) of Pub. L. 104–191, set out as a note under section 9801 of this title. § 9803. Guaranteed renewability in multi- employer plans and certain multiple em- ployer welfare arrangements (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 misrepre- sentation 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 re- gard to the claims experience of employers or a factor described in section 9802(a)(1) in rela- tion to such individuals or their dependents; or (6) for failure to meet the terms of an appli- cable collective bargaining agreement, to renew a collective bargaining or other agree- ment 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 ‘‘mul- tiple 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. (Added Pub. L. 104–191, title IV, § 401(a), Aug. 21, 1996, 110 Stat. 2079.) Page 4180 TITLE 26—INTERNAL REVENUE CODE [§ 9804 1 No section 9814 has been enacted. 2 No section 9821 has been enacted. Editorial Notes REFERENCES IN TEXT Section 3(40) of the Employee Retirement Income Se- curity Act of 1974, referred to in subsec. (b), is classified to section 1002(40) of Title 29, Labor. The date of the enactment of this section, referred to in subsec. (b), is the date of enactment of Pub. L. 104–191, which was approved Aug. 21, 1996. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section applicable to plan years beginning after June 30, 1997, see section 401(c) of Pub. L. 104–191, set out as a note under section 9801 of this title. [§ 9804. Renumbered § 9831] [§ 9805. Renumbered § 9832] [§ 9806. Renumbered § 9833] Subchapter B—Other Requirements Sec. 9811. Standards relating to benefits for mothers and newborns. 9812. Parity in mental health and substance use disorder benefits. 9813. Coverage of dependent students on medically necessary leave of absence. 9815. Additional market reforms.1 9816. Preventing surprise medical bills. 9817. Ending surprise air ambulance bills. 9818. Continuity of care. 9819. Maintenance of price comparison tool. 9820. Protecting patients and improving the accu- racy of provider directory information. 9822. Other patient protections.2 9823. Air ambulance report requirements. 9824. Increasing transparency by removing gag clauses on price and quality information. 9825. Reporting on pharmacy benefits and drug costs. Editorial Notes AMENDMENTS 2020—Pub. L. 116–260, div. BB, title I, §§ 102(c)(3), 105(a)(3)(B), 106(b)(3)(B), 113(b)(2), 114(b)(2), 116(d)(2), title II, §§ 201(d)(2), 204(d)(2), Dec. 27, 2020, 134 Stat. 2796, 2851, 2855, 2871, 2874, 2887, 2894, 2922, added items 9815 to 9820 and 9822 to 9825. 2008—Pub. L. 110–381, § 2(c)(2), Oct. 9, 2008, 122 Stat. 4086, added item 9813. Pub. L. 110–343, div. C, title V, § 512(g)(3)(B), Oct. 3, 2008, 122 Stat. 3892, added item 9812 and struck out former item 9812 ‘‘Parity in the application of certain limits to mental health benefits’’. 1997—Pub. L. 105–34, title XV, § 1531(a)(4), Aug. 5, 1997, 111 Stat. 1081, added subchapter heading and analysis. § 9811. Standards relating to benefits for mothers and newborns (a) Requirements for minimum hospital stay fol- lowing birth (1) In general A group health plan may not— (A) except as provided in paragraph (2)— (i) restrict benefits for any hospital length of stay in connection with child- birth for the mother or newborn child, fol- lowing a normal vaginal delivery, to less than 48 hours, or (ii) restrict benefits for any hospital length of stay in connection with child- birth for the mother or newborn child, fol- lowing a caesarean section, to less than 96 hours; or (B) require that a provider obtain author- ization from the plan or the issuer for pre- scribing any length of stay required under subparagraph (A) (without regard to para- graph (2)). (2) Exception Paragraph (1)(A) shall not apply in connec- tion with any group health plan in any case in which the decision to discharge the mother or her newborn child prior to the expiration of the minimum length of stay otherwise re- quired under paragraph (1)(A) is made by an attending provider in consultation with the mother. (b) Prohibitions A group health plan may not— (1) deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the re- quirements of this section; (2) provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section; (3) penalize or otherwise reduce or limit the reimbursement of an attending provider be- cause such provider provided care to an indi- vidual participant or beneficiary in accord- ance with this section; (4) provide incentives (monetary or other- wise) to an attending provider to induce such provider to provide care to an individual par- ticipant or beneficiary in a manner incon- sistent with this section; or (5) subject to subsection (c)(3), restrict bene- fits for any portion of a period within a hos- pital length of stay required under subsection (a) in a manner which is less favorable than the benefits provided for any preceding por- tion of such stay. (c) Rules of construction (1) Nothing in this section shall be construed to require a mother who is a participant or ben- eficiary— (A) to give birth in a hospital; or (B) to stay in the hospital for a fixed period of time following the birth of her child. (2) This section shall not apply with respect to any group health plan which does not provide benefits for hospital lengths of stay in connec- tion with childbirth for a mother or her newborn child. (3) Nothing in this section shall be construed as preventing a group health plan from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or newborn child under the plan, except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of