42 USC 300gg-21 - Exclusion of certain plans

U.S Code last checked for updates: Nov 23, 2024

§ 300gg–21.

Exclusion of certain plans

(a)

Limitation on application of provisions relating to group health plans

(1)

In general

The requirements of subparts 1 and 2 1

 See References in Text note below.

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

(A)

subject to paragraph (2), in the case of a plan that is a nonfederal governmental plan, and

(B)

with respect to health insurance coverage offered in connection with a group health plan (including such a plan that is a church plan or a governmental plan).

(2)

Treatment of non-Federal governmental plans

(A)

Election to be excluded

(B)

Period of election

An election under subparagraph (A) shall apply—

(i)

for a single specified plan year, or

(ii)

in the case of a plan provided pursuant to a collective bargaining agreement, for the term of such agreement.

An election under clause (i) may be extended through subsequent elections under this paragraph.

(C)

Notice to enrollees

Under such an election, the plan shall provide for—

(i)

notice to enrollees (on an annual basis and at the time of enrollment under the plan) of the fact and consequences of such election, and

(ii)

certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with section 2701(e).¹

(D)

Election not applicable to requirements concerning genetic information

(E)

Election not applicable

(F)

Sunset of election option

(i)

In general

Notwithstanding the preceding provisions of this paragraph—

(I)

no election described in subparagraph (A) with respect to section 300gg–26 of this title may be made on or after December 29, 2022; and

(II)

except as provided in clause (ii), no such election with respect to section 300gg–26 of this title expiring on or after the date that is 180 days after December 29, 2022, may be renewed.

(ii)

Exception for certain collectively bargained plans

(b)

Exception for certain benefits

(c)

Exception for certain benefits if certain conditions met

(1)

Limited, excepted benefits

The requirements of subparts 1 and 2 ¹ and part D shall not apply to any individual coverage or 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 300gg–91(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 or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer.

(3)

Supplemental excepted benefits

(d)

Treatment of partnerships

For purposes of this part and part D—

(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.

(July 1, 1944, ch. 373, title XXVII, § 2722, formerly § 2721, as added Pub. L. 104–191, title I, § 102(a), Aug. 21, 1996, 110 Stat. 1967; amended Pub. L. 104–204, title VI, § 604(b)(1), Sept. 26, 1996, 110 Stat. 2940; Pub. L. 110–233, title I, § 102(c), May 21, 2008, 122 Stat. 895; renumbered § 2735, renumbered § 2722, and amended Pub. L. 111–148, title I, §§ 1001(4), 1563(a), (c)(12), formerly § 1562(a), (c)(12), title X, § 10107(a), (b)(1), Mar. 23, 2010, 124 Stat. 130, 264, 268, 911; Pub. L. 116–260, div. BB, title I, § 102(a)(3)(B), Dec. 27, 2020, 134 Stat. 2772; Pub. L. 117–328, div. FF, title I, § 1321, Dec. 29, 2022, 136 Stat. 5697.)

cite as: 42 USC 300gg-21