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 the child described in subsection (b); (2) the manner in which the participant or beneficiary is covered under the plan changes, whether through a change in health insurance coverage or health insurance issuer, a change between health insurance coverage and self-in- sured coverage, or otherwise; and (3) the coverage as so changed continues to provide coverage of beneficiaries as dependent children, this section shall apply to coverage of the child under the changed coverage for the remainder of the period of the medically necessary leave of absence of the dependent child under the plan in the same manner as it would have applied if the changed coverage had been the previous cov- erage. (Pub. L. 93–406, title I, § 714, as added Pub. L. 110–381, § 2(a)(1), Oct. 9, 2008, 122 Stat. 4081.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section applicable with respect to plan years begin- ning on or after the date that is one year after Oct. 9, 2008, and to medically necessary leaves of absence be- ginning during such plan years, see section 2(d) of Pub. L. 110–381, set out as a note under section 9813 of Title 26, Internal Revenue Code. § 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 et seq.] (as amended by the Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers pro- viding health insurance coverage in connec- tion 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, 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. (Pub. L. 93–406, title I, § 715, as added Pub. L. 111–148, title I, § 1563(e), formerly § 1562(e), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 270, 911.) Editorial Notes REFERENCES IN TEXT The Public Health Service Act, referred to in text, is act July 1, 1944, ch. 373, 58 Stat. 682. Part A of title XXVII of the Act is classified generally to part A (§ 300gg et seq.) of subchapter XXV of chapter 6A of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under section 201 of Title 42 and Tables. The Patient Protection and Affordable Care Act, re- ferred to in text, is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of Title 42, The Public Health and Welfare, and Tables. CODIFICATION Pub. L. 111–148, which directed amendment of subpart B of part 7 of ‘‘subtitle A’’ of title I of the Employee Retirement Income Security Act of 1974 by adding this section at the end, was executed by adding this section at the end of this subpart, which is subpart B of part 7 of subtitle B of title I of the Act, to reflect the prob- able intent of Congress. § 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 cov- erage, provides or covers any benefits with re- spect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emer-