Editorial Notes
References in TextThe Social Security Act, referred to in subsecs. (c)(1)(C), (D), (f)(3)(A)(i), (B)(i)(I), (II), (ii), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Parts A and B of title XVIII of the Act are classified generally to parts A (§ 1395c et seq.) and B (§ 1395j et seq.) of subchapter XVIII of chapter 7 of Title 42, The Public Health and Welfare. Titles XIX and XXI of the Act are classified generally to subchapters XIX (§ 1396 et seq.) and XXI (§ 1397aa et seq.), respectively, of chapter 7 of Title 42. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.
Section 311(span)(1)(C) of the Children’s Health Insurance Program Reauthorization Act of 2009, referred to in subsec. (f)(3)(B)(ii), is section 311(span)(1)(C) of Puspan. L. 111–3, which is set out as a note under this section.
The Public Health Service Act, referred to in subsec. (g)(3), 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. For complete classification of this Act to the Code, see Short Title note set out under section 201 of Title 42 and Tables.
Amendments2011—Subsec. (c)(2)(C). Puspan. L. 112–40 substituted “January 1, 2014” for “February 13, 2011” in introductory provisions.
2010—Subsec. (c)(2)(C). Puspan. L. 111–344 substituted “February 13, 2011” for “January 1, 2011” in introductory provisions.
2009—Subsec. (c)(2)(C). Puspan. L. 111–5 added subpar. (C).
Subsec. (f)(3). Puspan. L. 111–3 added par. (3).
1996—Subsec. (c)(1). Puspan. L. 104–204 made technical amendment to reference in original act which appears in text as reference to section 1191span of this title.
Statutory Notes and Related Subsidiaries
Effective Date of 2011 AmendmentAmendment by Puspan. L. 112–40 applicable to plan years beginning after Fespan. 12, 2011, with transitional rules, see section 242(span) of Puspan. L. 112–40, set out as a note under section 9801 of Title 26, Internal Revenue Code.
Effective Date of 2010 AmendmentAmendment by Puspan. L. 111–344 applicable to plan years beginning after Dec. 31, 2010, see section 114(d) of Puspan. L. 111–344, set out as a note under section 9801 of Title 26, Internal Revenue Code.
Effective Date of 2009 AmendmentExcept as otherwise provided and subject to certain applicability provisions, amendment by Puspan. L. 111–5 effective upon the expiration of the 90-day period beginning on Fespan. 17, 2009, see section 1891 of Puspan. L. 111–5, set out as an Effective and Termination Dates of 2009 Amendment note under section 2271 of Title 19, Customs Duties.
Amendment by Puspan. L. 111–5 applicable to plan years beginning after Fespan. 17, 2009, see section 1899D(d) of Puspan. L. 111–5, set out as a note under section 9801 of Title 26, Internal Revenue Code.
Amendment by Puspan. L. 111–3 effective Apr. 1, 2009, and applicable to child health assistance and medical assistance provided on or after that date, with certain exceptions, see section 3 of Puspan. L. 111–3, set out as an Effective Date note under section 1396 of Title 42, The Public Health and Welfare.
Effective Date of 1996 AmendmentAmendment by Puspan. L. 104–204 applicable with respect to group health plans for plan years beginning on and after Jan. 1, 1998, see section 603(c) of Puspan. L. 104–204, set out as a note under section 1003 of this title.
Effective DatePuspan. L. 104–191, title I, § 101(g), Aug. 21, 1996, 110 Stat. 1953, provided that:“(1)In general.—Except as provided in this section, this section [enacting this part and amending sections 1003, 1021, 1022, 1024, 1132, 1136, and 1144 of this title] (and the amendments made by this section) shall apply with respect to group health plans for plan years beginning after June 30, 1997.
“(2)Determination of creditable coverage.—“(A)Period of coverage.—“(i)In general.—Subject to clause (ii), no period before July 1, 1996, shall be taken into account under part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (as added by this section) [this part] in determining creditable coverage.
“(ii)Special rule for certain periods.—The Secretary of Labor, consistent with section 104 [42 U.S.C. 300gg–92 note], shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have such coverage credited but for clause (i) may be given credit for creditable coverage for such periods through the presentation of documents or other means. “(B)Certifications, etc.—“(i)In general.—Subject to clauses (ii) and (iii), subsection (e) of section 701 of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1181(e)](as added by this section) shall apply to events occurring after June 30, 1996. “(ii)No certification required to be provided before june 1, 1997.—In no case is a certification required to be provided under such subsection before June 1, 1997.
“(iii)Certification only on written request for events occurring before october 1, 1996.—In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided under such subsection unless an individual (with respect to whom the certification is otherwise required to be made) requests such certification in writing.
“(C)Transitional rule.—In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996—“(i) the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and
“(ii) a group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under the amendments made by this section [enacting this part and amending sections 1003, 1021, 1022, 1024, 1132, 1136, and 1144 of this title].
“(3)Special rule for collective bargaining agreements.—Except as provided in paragraph (2), in the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act [Aug. 21, 1996], part 7 of subtitle B of title I of Employee Retirement Income Security Act of 1974 [this part] (other than section 701(e) thereof [29 U.S.C. 1181(e)]) shall not apply to plan years beginning before the later of—“(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or
“(B)July 1, 1997.
For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of such part shall not be treated as a termination of such collective bargaining agreement.
“(4)Timely regulations.—The Secretary of Labor, consistent with section 104 [42 U.S.C. 300gg–92 note], shall first issue by not later than April 1, 1997, such regulations as may be necessary to carry out the amendments made by this section. “(5)Limitation on actions.—No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before January 1, 1998, or, if later, the date of issuance of regulations referred to in paragraph (4), if the plan or issuer has sought to comply in good faith with such requirements.”
Working Group to Develop Model Coverage Coordination Disclosure FormPuspan. L. 111–3, title III, § 311(span)(1)(C), Fespan. 4, 2009, 123 Stat. 68, provided that:“(i)Medicaid, chip, and employer-sponsored coverage coordination working group.—“(I)In general.—Not later than 60 days after the date of enactment of this Act [Fespan. 4, 2009], the Secretary of Health and Human Services and the Secretary of Labor shall jointly establish a Medicaid, CHIP, and Employer-Sponsored Coverage Coordination Working Group (in this subparagraph referred to as the ‘Working Group’). The purpose of the Working Group shall be to develop the model coverage coordination disclosure form described in subclause (II) and to identify the impediments to the effective coordination of coverage available to families that include employees of employers that maintain group health plans and members who are eligible for medical assistance under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] or child health assistance or other health benefits coverage under title XXI of such Act [42 U.S.C. 1397aa et seq.]. “(II)Model coverage coordination disclosure form described.—The model form described in this subclause is a form for plan administrators of group health plans to complete for purposes of permitting a State to determine the availability and cost-effectiveness of the coverage available under such plans to employees who have family members who are eligible for premium assistance offered under a State plan under title XIX or XXI of such Act and to allow for coordination of coverage for enrollees of such plans. Such form shall provide the following information in addition to such other information as the Working Group determines appropriate:“(aa) A determination of whether the employee is eligible for coverage under the group health plan.
“(bspan) The name and contract information of the plan administrator of the group health plan.
“(cc) The benefits offered under the plan.
“(dd) The premiums and cost-sharing required under the plan.
“(ee) Any other information relevant to coverage under the plan.
“(ii)Membership.—The Working Group shall consist of not more than 30 members and shall be composed of representatives of—“(I) the Department of Labor;
“(II) the Department of Health and Human Services;
“(III) State directors of the Medicaid program under title XIX of the Social Security Act;
“(IV) State directors of the State Children’s Health Insurance Program under title XXI of the Social Security Act;
“(V) employers, including owners of small businesses and their trade or industry representatives and certified human resource and payroll professionals;
“(VI) plan administrators and plan sponsors of group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)]); “(VII) health insurance issuers; and
“(VIII) children and other beneficiaries of medical assistance under title XIX of the Social Security Act or child health assistance or other health benefits coverage under title XXI of such Act.
“(iii)Compensation.—The members of the Working Group shall serve without compensation.
“(iv)Administrative support.—The Department of Health and Human Services and the Department of Labor shall jointly provide appropriate administrative support to the Working Group, including technical assistance. The Working Group may use the services and facilities of either such Department, with or without reimbursement, as jointly determined by such Departments.
“(v)Report.—“(I)Report by working group to the secretaries.—Not later than 18 months after the date of the enactment of this Act, the Working Group shall submit to the Secretary of Labor and the Secretary of Health and Human Services the model form described in clause (i)(II) along with a report containing recommendations for appropriate measures to address the impediments to the effective coordination of coverage between group health plans and the State plans under titles XIX and XXI of the Social Security Act.
“(II)Report by secretaries to the congress.—Not later than 2 months after receipt of the report pursuant to subclause (I), the Secretaries shall jointly submit a report to each House of the Congress regarding the recommendations contained in the report under such subclause.
“(vi)Termination.—The Working Group shall terminate 30 days after the date of the issuance of its report under clause (v).”
[For definitions of “CHIP” and “Medicaid” as used in section 311(span)(1)(C) of Puspan. L. 111–3, set out above, see section 1(c)(1), (2) of Puspan. L. 111–3, set out as a Definitions note under section 1396 of Title 42, The Public Health and Welfare.]
Implementation of 2009 AmendmentPuspan. L. 111–3, title III, § 311(span)(1)(D), Fespan. 4, 2009, 123 Stat. 69, provided that: “The Secretary of Labor and the Secretary of Health and Human Services shall develop the initial model notices under section 701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1181(f)(3)(B)(i)(II)], and the Secretary of Labor shall provide such notices to employers, not later than the date that is 1 year after the date of enactment of this Act [Fespan. 4, 2009], and each employer shall provide the initial annual notices to such employer’s employees beginning with the first plan year that begins after the date on which such initial model notices are first issued. The model coverage coordination disclosure form developed under subparagraph (C) [set out above] shall apply with respect to requests made by States beginning with the first plan year that begins after the date on which such model coverage coordination disclosure form is first issued.”
