29 U.S.C. § 1191 — Preemption; State flexibility; construction

Page 611 TITLE 29—LABOR § 1191 1 So in original. Section 1181(d)(4) of this title does not contain subpars. 2 So in original. Section 1181(b)(2) of this title does not refer to a 30-day period. 3 So in original. Probably should be ‘‘1181(g)(1)(C)’’. (iii) costs for prescription drugs; and (iv) other medical costs, including wellness services; and (B) spending on prescription drugs by— (i) the health plan or coverage; and (ii) the participants and beneficiaries. (8) The average monthly premium— (A) paid by employers on behalf of partici- pants and beneficiaries, as applicable; and (B) paid by participants and beneficiaries. (9) Any impact on premiums by rebates, fees, and any other remuneration paid by drug man- ufacturers to the plan or coverage or its ad- ministrators or service providers, with respect to prescription drugs prescribed to partici- pants or beneficiaries in the plan or coverage, including— (A) the amounts so paid for each thera- peutic class of drugs; and (B) the amounts so paid for each of the 25 drugs that yielded the highest amount of re- bates and other remuneration under the plan or coverage from drug manufacturers during the plan year. (10) Any reduction in premiums and out-of- pocket costs associated with rebates, fees, or other remuneration described in paragraph (9). (b) Report Not later than 18 months after the date on which the first report is required under sub- section (a) and biannually thereafter, the Sec- retary, acting in coordination with the Inspec- tor General of the Department of Labor, shall make available on the internet website of the Department of Labor a report on prescription drug reimbursements under group health plans (or health insurance coverage offered in connec- tion with such a plan), prescription drug pricing trends, and the role of prescription drug costs in contributing to premium increases or decreases under such plans or coverage, aggregated in such a way as no drug or plan specific information will be made public. (c) Privacy protections No confidential or trade secret information submitted to the Secretary under subsection (a) shall be included in the report under subsection (b). (Pub. L. 93–406, title I, § 725, as added Pub. L. 116–260, div. BB, title II, § 204(b), Dec. 27, 2020, 134 Stat. 2919.) Subpart C—General Provisions § 1191. Preemption; State flexibility; construction (a) Continued applicability of State law with re- spect to health insurance issuers (1) In general Subject to paragraph (2) and except as pro- vided in subsection (b), this part shall not be construed to supersede any provision of State law which establishes, implements, or con- tinues in effect any standard or requirement solely relating to health insurance issuers in connection with group health insurance cov- erage except to the extent that such standard or requirement prevents the application of a requirement of this part. (2) Continued preemption with respect to group health plans Nothing in this part shall be construed to af- fect or modify the provisions of section 1144 of this title with respect to group health plans. (b) Special rules in case of portability require- ments (1) In general Subject to paragraph (2), the provisions of this part relating to health insurance coverage offered by a health insurance issuer supersede any provision of State law which establishes, implements, or continues in effect a standard or requirement applicable to imposition of a preexisting condition exclusion specifically governed by section 1181 of this title which dif- fers from the standards or requirements speci- fied in such section. (2) Exceptions Only in relation to health insurance cov- erage offered by a health insurance issuer, the provisions of this part do not supersede any provision of State law to the extent that such provision— (A) substitutes for the reference to ‘‘6- month period’’ in section 1181(a)(1) of this title a reference to any shorter period of time; (B) substitutes for the reference to ‘‘12 months’’ and ‘‘18 months’’ in section 1181(a)(2) of this title a reference to any shorter period of time; (C) substitutes for the references to ‘‘63 days’’ in sections 1181(c)(2)(A) and (d)(4)(A) 1 of this title a reference to any greater num- ber of days; (D) substitutes for the reference to ‘‘30-day period’’ in sections 1181(b)(2) 2 and (d)(1) of this title a reference to any greater period; (E) prohibits the imposition of any pre- existing condition exclusion in cases not de- scribed in section 1181(d) of this title or ex- pands the exceptions described in such sec- tion; (F) requires special enrollment periods in addition to those required under section 1181(f) of this title; or (G) reduces the maximum period permitted in an affiliation period under section 1181(g)(1)(B) 3 of this title. (c) Rules of construction Except as provided in section 1185 of this title, nothing in this part shall be construed as requir- ing a group health plan or health insurance cov- erage to provide specific benefits under the terms of such plan or coverage. (d) Definitions For purposes of this section— (1) State law The term ‘‘State law’’ includes all laws, de- cisions, rules, regulations, or other State ac- tion having the effect of law, of any State. A Page 612 TITLE 29—LABOR § 1191a law of the United States applicable only to the District of Columbia shall be treated as a State law rather than a law of the United States. (2) State The term ‘‘State’’ includes a State, the Northern Mariana Islands, any political sub- divisions of a State or such Islands, or any agency or instrumentality of either. (Pub. L. 93–406, title I, § 731, formerly § 704, as added Pub. L. 104–191, title I, § 101(a), Aug. 21, 1996, 110 Stat. 1946; renumbered § 731 and amend- ed Pub. L. 104–204, title VI, § 603(a)(3), (b)(1), Sept. 26, 1996, 110 Stat. 2935, 2937.) Editorial Notes AMENDMENTS 1996—Subsec. (c). Pub. L. 104–204, § 603(b)(1), sub- stituted ‘‘Except as provided in section 1185 of this title, nothing’’ for ‘‘Nothing’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1996 AMENDMENT Amendment by Pub. L. 104–204 applicable with re- spect to group health plans for plan years beginning on and after Jan. 1, 1998, see section 603(c) of Pub. L. 104–204, set out as a note under section 1003 of this title. EFFECTIVE DATE Section applicable with respect to group health plans for plan years beginning after June 30, 1997, except as otherwise provided, see section 101(g) of Pub. L. 104–191, set out as a note under section 1181 of this title. § 1191a. Special rules relating to group health plans (a) General exception for certain small group health plans The requirements of this part (other than sec- tion 1185 of this title) shall not apply to any group health plan (and group health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of such plan year, such plan has less than 2 par- ticipants who are current employees. (b) Exception for certain benefits The requirements of this part shall not apply to any group health plan (and group health in- surance coverage) in relation to its provision of excepted benefits described in section 1191b(c)(1) of this title. (c) Exception for certain benefits if certain con- ditions met (1) Limited, excepted benefits The requirements of this part shall not apply to any group health plan (and group health insurance coverage offered in connec- tion with a group health plan) in relation to its provision of excepted benefits described in section 1191b(c)(2) of this title 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 this part shall not apply to any group health plan (and group health insurance coverage offered in connec- tion with a group health plan) in relation to its provision of excepted benefits described in section 1191b(c)(3) of this title if all of the fol- lowing conditions are met: (A) The benefits are provided under a sepa- rate policy, certificate, or contract of insur- ance. (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. (3) Supplemental excepted benefits The requirements of this part shall not apply to any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in sec- tion 1191b(c)(4) 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— (1) Treatment as a group health plan Any plan, fund, or program which would not be (but for this subsection) an employee wel- fare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or program provides med- ical 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, reim- bursement, or otherwise, shall be treated (sub- ject 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 partner- ship, or (B) in connection with a group health plan maintained by a self-employed individual (under which one or more employees are par- ticipants), the self-employed individual, if such individual is, or may become, eligible to receive a benefit under the plan or such in- dividual’s beneficiaries may be eligible to re- ceive any such benefit. (Pub. L. 93–406, title I, § 732, formerly § 705, as added Pub. L. 104–191, title I, § 101(a), Aug. 21, 1996, 110 Stat. 1948; renumbered § 732 and amend- ed Pub. L. 104–204, title VI, § 603(a)(3), (b)(2), (3)(I)–(L), Sept. 26, 1996, 110 Stat. 2935, 2937, 2938.)