26 U.S.C. § 9815 — Untitled legal text

Page 4189 TITLE 26—INTERNAL REVENUE CODE § 9816 1 So in original. No section 9814 has been enacted. (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, pursuant to a medically necessary leave of absence of the child de- scribed 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. (Added Pub. L. 110–381, § 2(c)(1), Oct. 9, 2008, 122 Stat. 4084.) Editorial Notes REFERENCES IN TEXT Section 102 of the Higher Education Act of 1965, re- ferred to in subsec. (a), is classified to section 1002 of Title 20, Education. Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 110–381, § 2(d), Oct. 9, 2008, 122 Stat. 4086, pro- vided that: ‘‘The amendments made by this Act [enact- ing this section, section 1185c of Title 29, Labor, and sections 300gg–7 and 300gg–54 of Title 42, The Public Health and Welfare] shall apply with respect to plan years beginning on or after the date that is one year after the date of the enactment of this Act [Oct. 9, 2008] and to medically necessary leaves of absence beginning during such plan years.’’ § 9815.1 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 (as amended by the Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers providing health in- surance coverage in connection with group health plans, as if included in this subchapter; and (2) to the extent that any provision of this subchapter conflicts with a provision of such part A with respect to group health plans, or health insurance issuers providing health in- surance 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 (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 subchapter shall continue to apply to such plans as if such sections of the Public Health Service Act (as so amended) had not been enacted. (Added Pub. L. 111–148, title I, § 1563(f), formerly § 1562(f), 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. Sections 2716 and 2718 of title XXVII of the Act are classified to sec- tions 300gg–16 and 300gg–18, respectively, of Title 42. 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. § 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 emer- gency department of a hospital or with respect to emergency services in an independent free- standing emergency department (as defined in paragraph (3)(D)), the plan shall cover emer- gency services (as defined in paragraph (3)(C))— (A) without the need for any prior author- ization determination; (B) whether the health care provider fur- nishing such services is a participating pro- vider 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 non- participating 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 re- strictive than the requirements or limita- tions that apply to emergency services re- ceived from participating providers and participating emergency facilities with re- spect 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 partici- pating emergency facility were equal to the recognized amount (as defined in para-