Page 467 TITLE 29—LABOR § 1167

NOTIFICATION TO COVERED EMPLOYEES

Section 10002(e) of Pub. L. 99–272 provided that: ‘‘At

the time that the amendments made by this section

[enacting this part and amending section 1132 of this

title] apply to a group health plan (within the meaning

of section 607(1) of the Employee Retirement Income

Security Act of 1974 [29 U.S.C. 1167(1)]), the plan shall

notify each covered employee, and spouse of the employee (if any), who is covered under the plan at that

time of the continuation coverage required under part

6 of subtitle B of title I of such Act [this part]. The notice furnished under this subsection is in lieu of notice

that may otherwise be required under section 606(1) of

such Act [29 U.S.C. 1166(1)] with respect to such individuals.’’

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1132, 1162, 1165,

1167 of this title.

§ 1167. Definitions and special rules

For purposes of this part—

(1) Group health plan

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

care (as defined in section 213(d) of title 26) to

participants or beneficiaries directly or

through insurance, reimbursement, or otherwise. Such term shall not include any plan

substantially all of the coverage under which

is for qualified long-term care services (as defined in section 7702B(c) of title 26).

(2) Covered employee

The term ‘‘covered employee’’ means an individual who is (or was) provided coverage

under a group health plan by virtue of the performance of services by the individual for 1 or

more persons maintaining the plan (including

as an employee defined in section 401(c)(1) of

title 26).

(3) Qualified beneficiary

(A) In general

The term ‘‘qualified beneficiary’’ means,

with respect to a covered employee under a

group health plan, any other individual who,

on the day before the qualifying event for

that employee, is a beneficiary under the

plan—

(i) as the spouse of the covered employee, or

(ii) as the dependent child of the employee.

Such term shall also include a child who is

born to or placed for adoption with the covered employee during the period of continuation coverage under this part.

(B) Special rule for terminations and reduced employment

In the case of a qualifying event described

in section 1163(2) of this title, the term

‘‘qualified beneficiary’’ includes the covered

employee.

(C) Special rule for retirees and widows

In the case of a qualifying event described

in section 1163(6) of this title, the term

‘‘qualified beneficiary’’ includes a covered

employee who had retired on or before the

date of substantial elimination of coverage

and any other individual who, on the day before such qualifying event, is a beneficiary

under the plan—

(i) as the spouse of the covered employee,

(ii) as the dependent child of the employee, or

(iii) as the surviving spouse of the covered employee.

(4) Employer

Subsection (n) (relating to leased employees)

and subsection (t) (relating to application of

controlled group rules to certain employee

benefits) of section 414 of title 26 shall apply

for purposes of this part in the same manner

and to the same extent as such subsections

apply for purposes of section 106 of title 26.

Any regulations prescribed by the Secretary

pursuant to the preceding sentence shall be

consistent and coextensive with any regulations prescribed for similar purposes by the

Secretary of the Treasury (or such Secretary’s

delegate) under such subsections.

(5) Optional extension of required periods

A group health plan shall not be treated as

failing to meet the requirements of this part

solely because the plan provides both—

(A) that the period of extended coverage

referred to in section 1162(2) of this title

commences with the date of the loss of coverage, and

(B) that the applicable notice period provided under section 1166(a)(2) of this title

commences with the date of the loss of coverage.

(Pub. L. 93–406, title I, §607, as added Pub. L.

99–272, title X, §10002(a), Apr. 7, 1986, 100 Stat.

231; amended Pub. L. 99–509, title IX, §9501(c)(2),

Oct. 21, 1986, 100 Stat. 2077; Pub. L. 99–514, title

XVIII, §1895(d)(8), (9)(A), Oct. 22, 1986, 100 Stat.

2940; Pub. L. 100–647, title III, §3011(b)(6), Nov. 10,

1988, 102 Stat. 3625; Pub. L. 101–239, title VII,

§§7862(c)(2)(A), (6)(A), 7891(a)(1), (d)(2)(B)(i), Dec.

19, 1989, 103 Stat. 2432, 2433, 2445, 2446; Pub. L.

104–191, title III, §321(d)(2), title IV, §421(b)(3),

Aug. 21, 1996, 110 Stat. 2058, 2088.)

AMENDMENTS

1996—Par. (1). Pub. L. 104–191, §321(d)(2), inserted at

end ‘‘Such term shall not include any plan substantially all of the coverage under which is for qualified

long-term care services (as defined in section 7702B(c)

of title 26).’’

Par. (3)(A). Pub. L. 104–191, §421(b)(3), inserted at end

‘‘Such term shall also include a child who is born to or

placed for adoption with the covered employee during

the period of continuation coverage under this part.’’

1989—Pub. L. 101–239, §7891(d)(2)(B)(i)(I), inserted ‘‘and

special rules’’ after ‘‘Definitions’’ in section catchline.

Par. (1). Pub. L. 101–239, §7862(c)(6)(A), repealed Pub.

L. 100–647, §3011(b)(6), see 1988 Amendment note below.

Pub. L. 101–239, §7891(a)(1), substituted ‘‘Internal Revenue Code of 1986’’ for ‘‘Internal Revenue Code of 1954’’,

which for purposes of codification was translated as

‘‘title 26’’ thus requiring no change in text.

Par. (2). Pub. L. 101–239, §7862(c)(2)(A), substituted

‘‘the performance of services by the individual for 1 or

more persons maintaining the plan (including as an

employee defined in section 401(c)(1) of title 26)’’ for

‘‘the individual’s employment or previous employment

with an employer’’.

Par. (5). Pub. L. 101–239, §7891(d)(2)(B)(i)(II), added

par. (5).
§ 1168 TITLE 29—LABOR Page 468

1988—Par. (1). Pub. L. 100–647, §3011(b)(6), which directed amendment of par. (1) by substituting ‘‘section

162(i)(2) of title 26’’ for ‘‘section 162(i)(3) of title 26’’, was

repealed by Pub. L. 101–239, §7862(c)(6)(A).

Pub. L. 99–514, §1895(d)(8), amended par. (1) generally.

Prior to amendment, par. (1) read as follows: ‘‘The term

‘group health plan’ means an employee welfare benefit

plan that is a group health plan (within the meaning of

section 162(i)(3) of title 26).’’

Par. (3)(C). Pub. L. 99–509 added subpar. (C).

Par. (4). Pub. L. 99–514, §1895(d)(9)(A), added par. (4).

EFFECTIVE DATE OF 1996 AMENDMENT

Amendment by section 321(d)(2) of Pub. L. 104–191 applicable to contracts issued after Dec. 31, 1996, see section 321(f) of Pub. L. 104–191, set out as an Effective

Date note under section 7702B of Title 26, Internal Revenue Code.

Amendment by section 421(b)(3) of Pub. L. 104–191 effective Jan. 1, 1997, regardless of whether qualifying

event occurred before, on, or after such date, see section 421(d) of Pub. L. 104–191 set out as a note under section 4980B of Title 26.

EFFECTIVE DATE OF 1989 AMENDMENT

Amendment by section 7862(c)(2)(A) of Pub. L. 101–239

applicable to plan years beginning after Dec. 31, 1989,

see section 7862(c)(2)(C) of Pub. L. 101–239, set out as a

note under section 4980B of Title 26, Internal Revenue

Code.

Section 7862(c)(6)(B) of Pub. L. 101–239 provided that:

‘‘Subparagraph (A) [repealing section 3011(b)(6) of Pub.

L. 100–647, which amended this section] shall be effective as if included in the enactment of section 3011(b) of

the Technical and Miscellaneous Revenue Act of 1988

[Pub. L. 100–647].’’

Amendment by section 7891(a)(1) of Pub. L. 101–239 effective, except as otherwise provided, as if included in

the provision of the Tax Reform Act of 1986, Pub. L.

99–514, to which such amendment relates, see section

7891(f) of Pub. L. 101–239, set out as a note under section

1002 of this title.

Amendment by section 7891(d)(2)(B)(i) of Pub. L.

101–239 applicable with respect to plan years beginning

on or after Jan. 1, 1990, see section 7891(d)(2)(C) of Pub.

L. 101–239, set out as a note under section 4980B of Title

26, Internal Revenue Code.

EFFECTIVE DATE OF 1988 AMENDMENT

Amendment by Pub. L. 100–647 applicable to taxable

years beginning after Dec. 31, 1988, but not applicable

to any plan for any plan year to which section 162(k) of

Title 26, Internal Revenue Code (as in effect on the day

before Nov. 10, 1988) did not apply by reason of section

10001(e)(2) of Pub. L. 99–272, see section 3011(d) of Pub.

L. 100–647, set out as a note under section 162 of Title

26.

EFFECTIVE DATE OF 1986 AMENDMENTS

Section 1895(d)(9)(B) of Pub. L. 99–514 provided that:

‘‘The amendment made by subparagraph (A) [amending

this section] shall take effect in the same manner and

to the same extent as the amendments made by subsections (e) and (i) of section 1151 of this Act [amending

sections 132 and 414 of Title 26, Internal Revenue Code,

see section 1151(k) of Pub. L. 99–514, set out as an Effective Date note under section 89 of Title 26].’’

Amendment by section 1895(d)(8) of Pub. L. 99–514 effective, except as otherwise provided, as if included in

enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section

1895(e) of Pub. L. 99–514, set out as a note under section

162 of Title 26.

Amendment by Pub. L. 99–509 effective, except as

otherwise provided, as if included in title X of the Consolidated Omnibus Budget Reconciliation Act of 1985,

Pub. L. 99–272, see section 9501(e) of Pub. L. 99–509, set

out as a note under section 162 of Title 26.

PLAN AMENDMENTS NOT REQUIRED UNTIL

JANUARY 1, 1989

For provisions directing that if any amendments

made by subtitle A or subtitle C of title XI [§§1101–1147

and 1171–1177] or title XVIII [§§1800–1899A] of Pub. L.

99–514 require an amendment to any plan, such plan

amendment shall not be required to be made before the

first plan year beginning on or after Jan. 1, 1989, see

section 1140 of Pub. L. 99–514, as amended, set out as a

note under section 401 of Title 26, Internal Revenue

Code.

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1144, 1162, 1163,

1165 of this title; title 38 sections 4317, 4318; title 42 sections 1396a, 1396b, 1396g–1.

§ 1168. Regulations

The Secretary may prescribe regulations to

carry out the provisions of this part.

(Pub. L. 93–406, title I, §608, as added Pub. L.

99–272, title X, §10002(a), Apr. 7, 1986, 100 Stat.

231.)

§ 1169. Additional standards for group health

plans

(a) Group health plan coverage pursuant to medical child support orders

(1) In general

Each group health plan shall provide benefits in accordance with the applicable requirements of any qualified medical child support

order. A qualified medical child support order

with respect to any participant or beneficiary

shall be deemed to apply to each group health

plan which has received such order, from

which the participant or beneficiary is eligible

to receive benefits, and with respect to which

the requirements of paragraph (4) are met.

(2) Definitions

For purposes of this subsection—

(A) Qualified medical child support order

The term ‘‘qualified medical child support

order’’ means a medical child support

order—

(i) which creates or recognizes the existence of an alternate recipient’s right to, or

assigns to an alternate recipient the right

to, receive benefits for which a participant

or beneficiary is eligible under a group

health plan, and

(ii) with respect to which the requirements of paragraphs (3) and (4) are met.

(B) Medical child support order

The term ‘‘medical child support order’’

means any judgment, decree, or order (including approval of a settlement agreement)

which—

(i) provides for child support with respect to a child of a participant under a

group health plan or provides for health

benefit coverage to such a child, is made

pursuant to a State domestic relations law

(including a community property law), and

relates to benefits under such plan, or

(ii) enforces a law relating to medical

child support described in section 1908 of

the Social Security Act [42 U.S.C. 1396g–1]