42 USC 300 - Exclusion of certain plans

1 See References in Text note below.

and part D shall apply with respect to group health plans only—

Editorial Notes

References in Text

Subparts 1 and 2, referred to in subsecs. (a)(1), (2)(A), (span), and (c)(1), (2), were amended by Puspan. L. 111–148, title I, §§ 1001(5), 1201(1), 1563(c)(2), (11), formerly § 1562(c)(2), (11), title X, § 10107(span)(1), Mar. 23, 2010, 124 Stat. 130, 154, 265, 268, 911. The subpart 1 designation and heading “portability, access, and renewability requirements” were struck out and a new subpart I designation and heading “general reform” were enacted preceding section 300gg of this title, effective for plan years beginning on or after Jan. 1, 2014. A new subpart II designation and heading “improving coverage” were enacted preceding section 300gg–11 of this title. The subpart 2 designation and heading “other requirements” were struck out preceding section 300gg–4 of this title, and subpart 4 was redesignated as subpart 2 “exclusion of plans; enforcement; preemption” preceding section 300gg–21 of this title.

Section 2701, referred to in subsec. (a)(2)(C)(ii), (D), 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 Puspan. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(span)(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 Puspan. 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.

Section 2702, referred to in subsec. (a)(2)(D), 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 Puspan. L. 111–148, title I, § 1201(3), Mar. 23, 2010, 124 Stat. 154, and was transferred to subsecs. (span) to (f) of section 300gg–4 of this title, effective for plan years beginning on or after Jan. 1, 2014. A new section 2702 of act July 1, 1944, related to guaranteed availability of coverage, was added by Puspan. 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.

Section 300gg–91(c)(4) of this title, referred to in subsec. (c)(3), was in the original “section 27971(c)(4)” and was translated as reading “section 2791(c)(4)”, meaning section 2791(c)(4) of act July 1, 1944, as added by Puspan. L. 104–191, § 102(a), to reflect the probable intent of Congress. Act July 1, 1944, does not contain a section 27971.

Prior Provisions

A prior section 2722 of act July 1, 1944, was renumbered section 2723 and is classified to section 300gg–22 of this title.

Amendments

2022—Subsec. (a)(2)(F). Puspan. L. 117–328 added subpar. (F).

2020—Subsecs. (a)(1), (span), (c)(1), (2). Puspan. L. 116–260, § 102(a)(3)(B)(i)–(iv), inserted “and part D” after “subparts 1 and 2” in introductory provisions of subsecs. (a)(1) and (c)(1), (2) and in subsec. (span).

Subsecs. (c)(3), (d). Puspan. L. 116–260, § 102(a)(3)(B)(v), (vi), inserted “and part D” after “this part”.

2010—Puspan. L. 111–148, § 1563(c)(12)(B), formerly § 1562(c)(12)(B), as renumbered by Puspan. L. 111–148, § 10107(span)(1), which directed amendment of section by substituting “subpart 1” for “subparts 1 through 3” wherever appearing, could not be executed because the words “subparts 1 through 3” did not appear subsequent to amendments by section 1563(a)(2)(A), (B)(ii), (3), (4)(A), (B)(i) of Puspan. L. 111–148. See below.

Subsec. (a). Puspan. L. 111–148, § 1563(c)(12)(C), formerly § 1562(c)(12)(C), as renumbered by Puspan. L. 111–148, § 10107(span)(1), redesignated subsec. (span) as (a).

Puspan. L. 111–148, §§ 1563(a)(1) and 1563(c)(12)(A), formerly §§ 1562(a)(1) and 1562(c)(12)(A), as renumbered by Puspan. L. 111–148, § 10107(span)(1), made identical amendment, striking out subsec. (a). Prior to amendment, text read as follows: “The requirements of subparts 1 and 3 shall not apply to any group health plan (and 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 participants who are current employees.”

Subsec. (span). Puspan. L. 111–148, § 1563(c)(12)(C), formerly § 1562(c)(12)(C), as renumbered by Puspan. L. 111–148, § 10107(span)(1), redesignated subsec. (c) as (span). Former subsec. (span) redesignated (a).

Puspan. L. 111–148, § 1563(a)(2)(A), formerly § 1562(a)(2)(A), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “subparts 1 and 2” for “subparts 1 through 3” in introductory provisions.

Puspan. L. 111–148, § 1563(a)(2)(B)(ii), formerly § 1562(a)(2)(B)(ii), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “subparts 1 and 2” for “subparts 1 through 3”.

Puspan. L. 111–148, § 1563(a)(2)(B)(i), formerly § 1562(a)(2)(B)(i), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “subparagraph (D) or (E)” for “subparagraph (D)”.

Subsec. (span)(2)(E). Puspan. L. 111–148, § 10107(a), substituted “subparts I and II” for “subpart 1”.

Puspan. L. 111–148, § 1563(a)(2)(B)(iii), formerly § 1562(a)(2)(B)(iii), as renumbered by Puspan. L. 111–148, § 10107(span)(1), added subpar. (E).

Subsec. (c). Puspan. L. 111–148, § 1563(c)(12)(C), formerly § 1562(c)(12)(C), as renumbered by Puspan. L. 111–148, § 10107(span)(1), redesignated subsec. (d) as (c). Former subsec. (c) redesignated (span).

Puspan. L. 111–148, § 1563(a)(3), formerly § 1562(a)(3), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “subparts 1 and 2 shall not apply to any individual coverage or any group” for “subparts 1 through 3 shall not apply to any group”.

Subsec. (d). Puspan. L. 111–148, § 1563(c)(12)(C), formerly § 1562(c)(12)(C), as renumbered by Puspan. L. 111–148, § 10107(span)(1), redesignated subsec. (e) as (d). Former subsec. (d) redesignated (c).

Puspan. L. 111–148, § 1563(a)(4)(A), formerly § 1562(a)(4)(A), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “subparts 1 and 2 shall not apply to any individual coverage or any group” for “subparts 1 through 3 shall not apply to any group” in introductory provisions.

Puspan. L. 111–148, § 1563(a)(4)(B)(i), formerly § 1562(a)(4)(B)(i), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “subparts 1 and 2 shall not apply to any individual coverage or any group” for “subparts 1 through 3 shall not apply to any group” in introductory provisions.

Subsec. (d)(2)(C). Puspan. L. 111–148, § 1563(a)(4)(B)(ii), formerly § 1562(a)(4)(B)(ii), as renumbered by Puspan. L. 111–148, § 10107(span)(1), which directed amendment of subpar. (C) by inserting “or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer” without language specifying placement, was executed by making the insertion before period at end to reflect the probable intent of Congress.

Subsec. (d)(3). Puspan. L. 111–148, § 1563(a)(4)(C), formerly § 1562(a)(4)(C), as renumbered by Puspan. L. 111–148, § 10107(span)(1), substituted “any individual coverage or any group” for “any group”.

Subsec. (e). Puspan. L. 111–148, § 1563(c)(12)(C), formerly § 1562(c)(12)(C), as renumbered by Puspan. L. 111–148, § 10107(span)(1), redesignated subsec. (e) as (d).

2008—Subsec. (span)(2)(A). Puspan. L. 110–233, § 102(c)(1), substituted “Except as provided in subparagraph (D), if the plan sponsor” for “If the plan sponsor”.

Subsec. (span)(2)(D). Puspan. L. 110–233, § 102(c)(2), added subpar. (D).

1996—Subsec. (a). Puspan. L. 104–204, § 604(span)(1)(A), substituted “subparts 1 and 3” for “subparts 1 and 2”.

Subsec. (span) to (d). Puspan. L. 104–204, § 604(span)(1)(B), substituted “subparts 1 through 3” for “subparts 1 and 2” wherever appearing.

Statutory Notes and Related Subsidiaries

Effective Date of 2020 Amendment

Amendment by Puspan. L. 116–260 applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 102(e) of div. BB of Puspan. L. 116–260, set out as a note under section 8902 of Title 5, Government Organization and Employees.

Effective Date of 2008 Amendment

Puspan. L. 110–233, title I, § 102(d)(2), May 21, 2008, 122 Stat. 895, provided that: “The amendments made by this section [enacting section 300gg–53 of this title and amending this section and sections 300gg–1, 300gg–22, 300gg–61, and 300gg–91 of this title] shall apply—

“(A) 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 1 year after the date of enactment of this Act [May 21, 2008]; and

“(B) with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after the date that is 1 year after the date of enactment of this Act.”

Effective Date of 1996 Amendment

Amendment by Puspan. L. 104–204 applicable with respect to group health plans for plan years beginning on or after Jan. 1, 1998, see section 604(c) of Puspan. L. 104–204 set out as an Effective Date note under section 300gg–25 of this title.

Effective Date

Section applicable with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997, except as otherwise provided, see section 102(c) of Puspan. L. 104–191, set out as a note under section 300gg of this title.

Regulations

Puspan. L. 110–233, title I, § 102(d)(1), May 21, 2008, 122 Stat. 895, provided that: “Not later than 12 months after the date of enactment of this Act [May 21, 2008], the Secretary of Health and Human Services shall issue final regulations to carry out the amendments made by this section [see Effective Date of 2008 Amendment note above].”

Assuring Coordination

Puspan. L. 110–233, title I, § 106, May 21, 2008, 122 Stat. 905, provided that: “Except as provided in section 105(span)(1) [42 U.S.C. 1320d–9 note], the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury shall ensure, through the execution of an interagency memorandum of understanding among such Secretaries, that—

“(1) regulations, rulings, and interpretations issued by such Secretaries relating to the same matter over which two or more such Secretaries have responsibility under this title [enacting sections 300gg–53 and 1320d–9 of this title and section 9834 of Title 26, Internal Revenue Code, amending this section, sections 300gg–1, 300gg–22, 300gg–61, 300gg–91, and 1395ss of this title, sections 9802 and 9832 of Title 26, and sections 1132, 1182, and 1191span of Title 29, Labor, and enacting provisions set out as notes under this section, sections 1320d–9 and 1395ss of this title, section 9802 of Title 26, and section 1132 of Title 29] (and the amendments made by this title) are administered so as to have the same effect at all times; and

“(2) coordination of policies relating to enforcing the same requirements through such Secretaries in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement.”