29 USC 1191a - Special rules relating to group health plans

U.S Code last checked for updates: Jan 18, 2025

§ 1191a.

Special rules relating to group health plans

(a)

General exception for certain small group health plans

(b)

Exception for certain benefits

(c)

Exception for certain benefits if certain conditions 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 connection 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

(A)

The benefits are provided under a separate policy, certificate, or contract of insurance.

(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

(d)

Treatment of partnerships

For purposes of this part—

(1)

Treatment as a group health plan

(2)

Employer

(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 partnership, or

(B)

in connection with a group health plan maintained by a self-employed individual (under which one or more employees are participants), the self-employed individual,

if such individual is, or may become, eligible to receive a benefit under the plan or such individual’s beneficiaries may be eligible to receive 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 amended Pub. L. 104–204, title VI, § 603(a)(3), (b)(2), (3)(I)–(L), Sept. 26, 1996, 110 Stat. 2935, 2937, 2938.)

cite as: 29 USC 1191a