Page 475 TITLE 29—LABOR § 1182

‘‘(ii) SPECIAL RULE FOR CERTAIN PERIODS.—The

Secretary of Labor, consistent with section 104 [42

U.S.C. 300gg–92 note], shall provide for a process

whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and

who would have such coverage credited but for

clause (i) may be given credit for creditable coverage for such periods through the presentation of

documents or other means.

‘‘(B) CERTIFICATIONS, ETC.—

‘‘(i) IN GENERAL.—Subject to clauses (ii) and (iii),

subsection (e) of section 701 of the Employee Retirement Income Security Act of 1974 [29 U.S.C.

1181(e)](as added by this section) shall apply to

events occurring after June 30, 1996.

‘‘(ii) NO CERTIFICATION REQUIRED TO BE PROVIDED

BEFORE JUNE 1, 1997.—In no case is a certification required to be provided under such subsection before

June 1, 1997.

‘‘(iii) CERTIFICATION ONLY ON WRITTEN REQUEST

FOR EVENTS OCCURRING BEFORE OCTOBER 1, 1996.—In

the case of an event occurring after June 30, 1996,

and before October 1, 1996, a certification is not required to be provided under such subsection unless

an individual (with respect to whom the certification is otherwise required to be made) requests

such certification in writing.

‘‘(C) TRANSITIONAL RULE.—In the case of an individual who seeks to establish creditable coverage for any

period for which certification is not required because

it relates to an event occurring before June 30, 1996—

‘‘(i) the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and

‘‘(ii) a group health plan and a health insurance

issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the

plan or issuer has sought to comply in good faith

with the applicable requirements under the amendments made by this section [enacting this part and

amending sections 1003, 1021, 1022, 1024, 1132, 1136,

and 1144 of this title].

‘‘(3) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—Except as provided in paragraph (2), in the

case of a group health plan maintained pursuant to one

or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act [Aug.

21, 1996], part 7 of subtitle B of title I of Employee Retirement Income Security Act of 1974 [this part] (other

than section 701(e) thereof [29 U.S.C. 1181(e)]) shall not

apply to plan years beginning before the later of—

‘‘(A) the date on which the last of the collective

bargaining agreements relating to the plan terminates (determined without regard to any extension

thereof agreed to after the date of the enactment of

this Act), or

‘‘(B) July 1, 1997.

For purposes of subparagraph (A), any plan amendment

made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of such part shall not be

treated as a termination of such collective bargaining

agreement.

‘‘(4) TIMELY REGULATIONS.—The Secretary of Labor,

consistent with section 104 [42 U.S.C. 300gg–92 note],

shall first issue by not later than April 1, 1997, such regulations as may be necessary to carry out the amendments made by this section.

‘‘(5) LIMITATION ON ACTIONS.—No enforcement action

shall be taken, pursuant to the amendments made by

this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before January 1,

1998, or, if later, the date of issuance of regulations referred to in paragraph (4), if the plan or issuer has

sought to comply in good faith with such requirements.’’

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in sections 1182, 1191 of this

title.

§ 1182. Prohibiting discrimination against individual participants and beneficiaries based

on health status

(a) In eligibility to enroll

(1) In general

Subject to paragraph (2), a group health

plan, and a health insurance issuer offering

group health insurance coverage in connection

with a group health plan, may not establish

rules for eligibility (including continued eligibility) of any individual to enroll under the

terms of the plan based on any of the following health status-related factors in relation to

the individual or a dependent of the individual:

(A) Health status.

(B) Medical condition (including both

physical and mental illnesses).

(C) Claims experience.

(D) Receipt of health care.

(E) Medical history.

(F) Genetic information.

(G) Evidence of insurability (including

conditions arising out of acts of domestic

violence).

(H) Disability.

(2) No application to benefits or exclusions

To the extent consistent with section 1181 of

this title, paragraph (1) shall not be construed—

(A) to require a group health plan, or

group health insurance coverage, to provide

particular benefits other than those provided under the terms of such plan or coverage, or

(B) to prevent such a plan or coverage

from establishing limitations or restrictions

on the amount, level, extent, or nature of

the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.

(3) Construction

For purposes of paragraph (1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for such

enrollment.

(b) In premium contributions

(1) In general

A group health plan, and a health insurance

issuer offering health insurance coverage in

connection with a group health plan, may not

require any individual (as a condition of enrollment or continued enrollment under the

plan) to pay a premium or contribution which

is greater than such premium or contribution

for a similarly situated individual enrolled in

the plan on the basis of any health status-related factor in relation to the individual or to

an individual enrolled under the plan as a dependent of the individual.

(2) Construction

Nothing in paragraph (1) shall be construed—
§ 1183 TITLE 29—LABOR Page 476

(A) to restrict the amount that an employer may be charged for coverage under a

group health plan; or

(B) to prevent a group health plan, and a

health insurance issuer offering group

health insurance coverage, from establishing

premium discounts or rebates or modifying

otherwise applicable copayments or deductibles in return for adherence to programs of

health promotion and disease prevention.

(Pub. L. 93–406, title I, §702, as added Pub. L.

104–191, title I, §101(a), Aug. 21, 1996, 110 Stat.

1945.)

SECTION REFERRED TO IN OTHER SECTIONS

This section is referred to in section 1191b of this

title.

§ 1183. Guaranteed renewability in multiemployer plans and multiple employer welfare

arrangements

A group health plan which is a multiemployer

plan or which is a multiple employer welfare arrangement may not deny an employer whose

employees are covered under such a plan continued access to the same or different coverage

under the terms of such a plan, other than—

(1) for nonpayment of contributions;

(2) for fraud or other intentional misrepresentation of material fact by the employer;

(3) for noncompliance with material plan

provisions;

(4) because the plan is ceasing to offer any

coverage in a geographic area;

(5) in the case of a plan that offers benefits

through a network plan, there is no longer any

individual enrolled through the employer who

lives, resides, or works in the service area of

the network plan and the plan applies this

paragraph uniformly without regard to the

claims experience of employers or any health

status-related factor in relation to such individuals or their dependents; and

(6) for failure to meet the terms of an applicable collective bargaining agreement, to

renew a collective bargaining or other agreement requiring or authorizing contributions to

the plan, or to employ employees covered by

such an agreement.

(Pub. L. 93–406, title I, §703, as added Pub. L.

104–191, title I, §101(a), Aug. 21, 1996, 110 Stat.

1946.)

Subpart B—Other Requirements

§ 1185. Standards relating to benefits for mothers

and newborns

(a) Requirements for minimum hospital stay following birth

(1) In general

A group health plan, and a health insurance

issuer offering group health insurance coverage, may not—

(A) except as provided in paragraph (2)—

(i) restrict benefits for any hospital

length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less

than 48 hours, or

(ii) restrict benefits for any hospital

length of stay in connection with childbirth for the mother or newborn child, following a cesarean section, to less than 96

hours; or

(B) require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under

subparagraph (A) (without regard to paragraph (2)).

(2) Exception

Paragraph (1)(A) shall not apply in connection with any group health plan or health insurance issuer in any case in which the decision to discharge the mother or her newborn

child prior to the expiration of the minimum

length of stay otherwise required under paragraph (1)(A) is made by an attending provider

in consultation with the mother.

(b) Prohibitions

A group health plan, and a health insurance issuer offering group health insurance coverage in

connection with a group health plan, may not—

(1) deny to the mother or her newborn child

eligibility, or continued eligibility, to enroll

or to renew coverage under the terms of the

plan, solely for the purpose of avoiding the requirements of this section;

(2) provide monetary payments or rebates to

mothers to encourage such mothers to accept

less than the minimum protections available

under this section;

(3) penalize or otherwise reduce or limit the

reimbursement of an attending provider because such provider provided care to an individual participant or beneficiary in accordance with this section;

(4) provide incentives (monetary or otherwise) to an attending provider to induce such

provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or

(5) subject to subsection (c)(3) of this section, restrict benefits for any portion of a period within a hospital length of stay required

under subsection (a) of this section in a manner which is less favorable than the benefits

provided for any preceding portion of such

stay.

(c) Rules of construction

(1) Nothing in this section shall be construed

to require a mother who is a participant or beneficiary—

(A) to give birth in a hospital; or

(B) to stay in the hospital for a fixed period

of time following the birth of her child.

(2) This section shall not apply with respect to

any group health plan, or any group health insurance coverage offered by a health insurance

issuer, which does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

(3) Nothing in this section shall be construed

as preventing a group health plan or issuer from

imposing deductibles, coinsurance, or other

cost-sharing in relation to benefits for hospital

lengths of stay in connection with childbirth for

a mother or newborn child under the plan (or