Page 479 TITLE 29—LABOR § 1191a

(f) Sunset

This section shall not apply to benefits for

services furnished on or after September 30, 2001.

(Pub. L. 93–406, title I, §712, as added Pub. L.

104–204, title VII, §702(a), Sept. 26, 1996, 110 Stat.

2944.)

EFFECTIVE DATE

Section 702(c) of Pub. L. 104–204 provided that: ‘‘The

amendments made by this section [enacting this section] shall apply with respect to group health plans for

plan years beginning on or after January 1, 1998.’’

Subpart C—General Provisions

§ 1191. Preemption; State flexibility; construction

(a) Continued applicability of State law with respect to health insurance issuers

(1) In general

Subject to paragraph (2) and except as provided in subsection (b) of this section, this

part shall not be construed to supersede any

provision of State law which establishes, implements, or continues in effect any standard

or requirement solely relating to health insurance issuers in connection with group health

insurance coverage except to the extent that

such standard or requirement prevents the application of a requirement of this part.

(2) Continued preemption with respect to

group health plans

Nothing in this part shall be construed to affect or modify the provisions of section 1144 of

this title with respect to group health plans.

(b) Special rules in case of portability requirements

(1) In general

Subject to paragraph (2), the provisions of

this part relating to health insurance coverage

offered by a health insurance issuer supersede

any provision of State law which establishes,

implements, or continues in effect a standard

or requirement applicable to imposition of a

preexisting condition exclusion specifically

governed by section 1181 of this title which differs from the standards or requirements specified in such section.

(2) Exceptions

Only in relation to health insurance coverage offered by a health insurance issuer, the

provisions of this part do not supersede any

provision of State law to the extent that such

provision—

(A) substitutes for the reference to ‘‘6-

month period’’ in section 1181(a)(1) of this

title a reference to any shorter period of

time;

(B) substitutes for the reference to ‘‘12

months’’ and ‘‘18 months’’ in section

1181(a)(2) of this title a reference to any

shorter period of time;

(C) substitutes for the references to ‘‘63

days’’ in sections 1181(c)(2)(A) and (d)(4)(A)

of this title a reference to any greater number of days;

(D) substitutes for the reference to ‘‘30-day

period’’ in sections 1181(b)(2) and (d)(1) of

this title a reference to any greater period;

(E) prohibits the imposition of any preexisting condition exclusion in cases not described in section 1181(d) of this title or expands the exceptions described in such section;

(F) requires special enrollment periods in

addition to those required under section

1181(f) of this title; or

(G) reduces the maximum period permitted

in an affiliation period under section

1181(g)(1)(B) of this title.

(c) Rules of construction

Except as provided in section 1185 of this title,

nothing in this part shall be construed as requiring a group health plan or health insurance coverage to provide specific benefits under the

terms of such plan or coverage.

(d) Definitions

For purposes of this section—

(1) State law

The term ‘‘State law’’ includes all laws, decisions, rules, regulations, or other State action having the effect of law, of any State. A

law of the United States applicable only to the

District of Columbia shall be treated as a

State law rather than a law of the United

States.

(2) State

The term ‘‘State’’ includes a State, the

Northern Mariana Islands, any political subdivisions of a State or such Islands, or any

agency or instrumentality of either.

(Pub. L. 93–406, title I, §731, formerly §704, as

added Pub. L. 104–191, title I, §101(a), Aug. 21,

1996, 110 Stat. 1946; renumbered §731 and amended Pub. L. 104–204, title VI, §603(a)(3), (b)(1),

Sept. 26, 1996, 110 Stat. 2935, 2937.)

AMENDMENTS

1996—Subsec. (c). Pub. L. 104–204, §603(b)(1), substituted ‘‘Except as provided in section 1185 of this

title, nothing’’ for ‘‘Nothing’’.

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by Pub. 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 Pub. L.

104–204, set out as a note under section 1003 of this title.

EFFECTIVE DATE

Section applicable with respect to group health plans

for plan years beginning after June 30, 1997, except as

otherwise provided, see section 101(g) of Pub. L. 104–191,

set out as a note under section 1181 of this title.

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1144, 1185 of this

title.

§ 1191a. Special rules relating to group health

plans

(a) General exception for certain small group

health plans

The requirements of this part (other than section 1185 of this title) shall not apply to any

group health plan (and group 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.
§ 1191b TITLE 29—LABOR Page 480

(b) Exception for certain benefits

The requirements of this part shall not apply

to any group health plan (and group health insurance coverage) in relation to its provision of

excepted benefits described in section 1191b(c)(1)

of this title.

(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

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)(3) of this title if all of the following conditions are met:

(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

The requirements of this part shall not

apply to any group health plan (and group

health insurance coverage) in relation to its

provision of excepted benefits described in section 1191b(c)(4) of this title if the benefits are

provided under a separate policy, certificate,

or contract of insurance.

(d) Treatment of partnerships

For purposes of this part—

(1) Treatment as a group health plan

Any plan, fund, or program which would not

be (but for this subsection) an employee welfare benefit plan and which is established or

maintained by a partnership, to the extent

that such plan, fund, or program provides medical care (including items and services paid for

as medical care) to present or former partners

in the partnership or to their dependents (as

defined under the terms of the plan, fund, or

program), directly or through insurance, reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare

benefit plan which is a group health plan.

(2) Employer

In the case of a group health plan, the term

‘‘employer’’ also includes the partnership in

relation to any partner.

(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.)

AMENDMENTS

1996—Subsec. (a). Pub. L. 104–204, §603(b)(2), inserted

‘‘(other than section 1185 of this title)’’ after ‘‘part’’.

Subsecs. (b), (c)(1) to (3). Pub. L. 104–204,

§603(b)(3)(I)–(L), made technical amendment to references in original act which appear in text as references to section 1191b of this title.

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by Pub. 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 Pub. L.

104–204, set out as a note under section 1003 of this title.

EFFECTIVE DATE

Section applicable with respect to group health plans

for plan years beginning after June 30, 1997, except as

otherwise provided, see section 101(g) of Pub. L. 104–191,

set out as a note under section 1181 of this title.

§ 1191b. Definitions

(a) Group health plan

For purposes of this part—

(1) In general

The term ‘‘group health plan’’ means an employee welfare benefit plan 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.

(2) Medical care

The term ‘‘medical care’’ means amounts

paid for—

(A) the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts

paid for the purpose of affecting any structure or function of the body,

(B) amounts paid for transportation primarily for and essential to medical care referred to in subparagraph (A), and

(C) amounts paid for insurance covering

medical care referred to in subparagraphs

(A) and (B).

(b) Definitions relating to health insurance

For purposes of this part—

(1) Health insurance coverage

The term ‘‘health insurance coverage’’

means benefits consisting of medical care