42 U.S.C. § 300gg-91
The term "group health plan" means an employee welfare benefit plan (as defined in section 3(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(1)] ) to the extent that the plan provides medical care (as defined in paragraph (2)) and including items and services paid for as medical care) to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Except for purposes of part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.), such term shall not include any qualified small employer health reimbursement arrangement (as defined in section 9831(d)(2) of title 26).
The term "medical care" means amounts paid for-
A program under which creditable coverage described in subparagraph (C), (D), (E), or (F) of section 2701(c)(1)1 is provided shall be treated as a group health plan for purposes of applying section 2701(e).1
The term "health insurance coverage" means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.
The term "health insurance issuer" means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1144(b)(2)] ). Such term does not include a group health plan.
The term "health maintenance organization" means-
The term "group health insurance coverage" means, in connection with a group health plan, health insurance coverage offered in connection with such plan.
The term "individual health insurance coverage" means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance.
For purposes of this subchapter, the term "excepted benefits" means benefits under one or more (or any combination thereof) of the following:
Medicare supplemental health insurance (as defined under section 1395ss(g)(1) of this title), coverage supplemental to the coverage provided under chapter 55 of title 10, and similar supplemental coverage provided to coverage under a group health plan.
The term "applicable State authority" means, with respect to a health insurance issuer in a State, the State insurance commissioner or official or officials designated by the State to enforce the requirements of this subchapter for the State involved with respect to such issuer.
The term "beneficiary" has the meaning given such term under section 3(8) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(8)] .
The term "bona fide association" means, with respect to health insurance coverage offered in a State, an association which-
The term "COBRA continuation provision" means any of the following:
The term "employee" has the meaning given such term under section 3(6) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(6)] .
The term "employer" has the meaning given such term under section 3(5) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(5)], except that such term shall include only employers of two or more employees.
The term "church plan" has the meaning given such term under section 3(33) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(33)] .
The term "health status-related factor" means any of the factors described in section 2702(a)(1).1
The term "network plan" means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, in whole or in part, through a defined set of providers under contract with the issuer.
The term "participant" has the meaning given such term under section 3(7) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(7)] .
The term "placement", or being "placed", for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child's placement with such person terminates upon the termination of such legal obligation.
The term "plan sponsor" has the meaning given such term under section 3(16)(B) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1002(16)(B)] .
The term "State" means each of the several States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
The term "family member" means, with respect to any individual-
The term "genetic information" means, with respect to any individual, information about-
Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.
The term "genetic information" shall not include information about the sex or age of any individual.
The term "genetic test" means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.
The term "genetic test" does not mean-
The term "genetic services" means-
The term "underwriting purposes" means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan-
The term "qualified health plan" has the meaning given such term in section 18021(a) of this title.
The term "Exchange" means an American Health Benefit Exchange established under section 18031 of this title.
For purposes of this subchapter:
The term "individual market" means the market for health insurance coverage offered to individuals other than in connection with a group health plan.
Subject to clause (ii), such terms2 includes coverage offered in connection with a group health plan that has fewer than two participants as current employees on the first day of the plan year.
Clause (i) shall not apply in the case of a State that elects to regulate the coverage described in such clause as coverage in the small group market.
The term "large employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least 2 employees on the first day of the plan year.
The term "large group market" means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer.
The term "small employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 50 employees on business days during the preceding calendar year and who employs at least 1 employees3 on the first day of the plan year.
The term "small group market" means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a small employer.
For purposes of this subsection-
all4 persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of title 26 shall be treated as 1 employer.
In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.
Any reference in this subsection to an employer shall include a reference to any predecessor of such employer.
Notwithstanding paragraphs (2) and (4), nothing in this section shall prevent a State from applying this subsection by treating as a small employer, with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 100 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
1See References in Text note below.
2So in original. Probably should be "term".
3So in original.
4So in original. Probably should be capitalized.
42 U.S.C. § 300gg-91
EDITORIAL NOTES
REFERENCES IN TEXTThe Social Security Act, referred to in subsec. (a)(1), 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 this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.Section 2701, referred to in subsecs. (a)(3) and (d)(15)(A), is a reference to section 2701 of act July 1, 1944. Section 2701, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111-148, title I, §§1201(2), 1563, formerly §1562(c)(1), title X, §10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg-3 of this title. A new section 2701 of act July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111-148, title I, §1201(4), title X, §10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title. The Employee Retirement Income Security Act of 1974, referred to in subsec. (d)(4)(B), is Pub. L. 93-406, Sept. 2, 1974, 88 Stat. 829. Part 6 of subtitle B of title I of the Act is classified generally to part 6 (§1161 et seq.) of subtitle B of subchapter I of chapter 18 of Title 29, Labor. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of Title 29 and Tables.Section 2702, referred to in subsec. (d)(9), is a reference to section 2702 of act July 1, 1944. Section 2702, which was classified to section 300gg-1 of this title, was amended by Pub. L. 111-148, title I, §1201(3), Mar. 23, 2010, 124 Stat. 154, and was transferred to subsecs. (b) to (f) of section 300gg-4 of this title, effective for plan years beginning on or after Jan. 1, 2014. A new section 2702, related to guaranteed availability of coverage, was added by Pub. L. 111-148, title I, §1201(4), Mar. 23, 2010, 124 Stat. 156, effective for plan years beginning on or after Jan. 1, 2014, and is classified to section 300gg-1 of this title.
AMENDMENTS2016-Subsec. (a)(1). Pub. L. 114-255 inserted at end "Except for purposes of part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.), such term shall not include any qualified small employer health reimbursement arrangement (as defined in section 9831(d)(2) of title 26)."2015-Subsec. (e)(2). Pub. L. 114-60, §2(b)(1), substituted "51" for "101".Subsec. (e)(4). Pub. L. 114-60, §2(b)(2), substituted "50" for "100". Subsec. (e)(7). Pub. L. 114-60, §2(b)(3), added par. (7). 2010-Subsec. (d)(20), (21). Pub. L. 111-148, §1563(b), formerly §1562(b), as renumbered by Pub. L. 111-148, §10107(b)(1), added pars. (20) and (21). Subsec. (e)(2). Pub. L. 111-148, §1563(c)(16)(A), formerly §1562(c)(16)(A), as renumbered by Pub. L. 111-148, §10107(b)(1), substituted "101" for "51".Subsec. (e)(4). Pub. L. 111-148, §1563(c)(16)(B), formerly §1562(c)(16)(B), as renumbered by Pub. L. 111-148, §10107(b)(1), substituted "100" for "50" and "at least 1" for "at least 2" in two places.2008-Subsec. (d)(15) to (19). Pub. L. 110-233 added pars. (15) to (19).
STATUTORY NOTES AND RELATED SUBSIDIARIES
EFFECTIVE DATE OF 2016 AMENDMENT Amendment by Pub. L. 114-255 applicable to plan years beginning after Dec. 31, 2016, see section 18001(c)(3) of Pub. L. 114-255 set out as a note under section 300bb-8 of this title.
EFFECTIVE DATE OF 2008 AMENDMENT Amendment by Pub. L. 110-233 applicable, with respect to group health plans and health insurance coverage offered in connection with group health plans, for plan years beginning after the date that is one year after May 21, 2008, and, with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market, after the date that is one year after May 21, 2008, see section 102(d)(2) of Pub. L. 110-233 set out as a note under section 300gg-21 of this title.
- Service
- The term "Service" means the Public Health Service;