Sec. 3. Prohibiting discrimination based on health status
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Subpart 3 of part A of title XXVII of the Public Health Service Act is amended by striking section 2711 of such Act ( 42 U.S.C. 300gg–11 ) and inserting the following: Subject to subsections
(b)through (e), each health insurance issuer that offers health insurance coverage in the group market in a State shall accept every employer and every individual in a group in the State that applies for such coverage. An association shall be treated as an employer for purposes of this section if such association seeks to provide group health insurance coverage to not less than 200 qualified individuals. A health insurance issuer described in subsection
(a)may restrict enrollment in coverage described in such subsection to open or special enrollment periods. A health insurance issuer described in subsection
(a)shall, in accordance with the regulations promulgated under paragraph (3), establish special enrollment periods for qualifying events (as such term is defined in section 603 of the Employee Retirement Income Security Act of 1974). For purposes of applying paragraph
(2)to an association— the term covered employee in section 603 of the Employee Retirement Income Security Act of 1974 shall include a qualified individual (as such term is defined in section 2701(d)(2)(D)); the term employer shall include an association (as such term is defined in section 2701(d)(2)(A)); and the term termination (other than by reason of such employee's gross misconduct), or reduction of hours, of the covered employee's employment shall include the termination of membership to the association. With respect to health insurance coverage provided to an association under subsection (a)(2) , a health insurance issuer shall permit a qualified individual who is eligible, but not enrolled (or a dependent of such individual if the dependent is eligible, but not enrolled) for such coverage to enroll for coverage under the terms of such coverage when any one of the following events occur: A qualified individual, and any dependent of such individual, may enroll during the 30-day period following the end of the period described under section 2701(d)(2)(D) that applies to such individual. A qualified individual, and any dependent of such individual, may enroll during the annual enrollment period established under the terms of the coverage With respect to group health insurance coverage provided by an association, a qualified individual or dependent who terminates enrollment in such coverage may only re-enroll in such coverage during the annual enrollment period described under subparagraph (B)(ii) . For purposes of this section, the terms association and qualified individual have the meaning given such terms in section 2701(d)(2). The Secretary shall promulgate regulations with respect to enrollment periods under this subsection. In the case of a health insurance issuer that offers health insurance coverage in the group market in a State through a network plan, the issuer may— limit the employers that may apply for such coverage to those with eligible individuals who live, work, or reside in the service area for such network plan; and within the service area of such plan, deny such coverage to such employers if the issuer has demonstrated, if required, to the applicable State authority that— it will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and it is applying this paragraph uniformly to all employers without regard to— the claims experience of those employers and their employees (and their dependents); or any health-status-related factor relating to such employees and dependents. 180- day suspension upon denial of coverage An issuer, upon denying health insurance coverage in any service area in accordance with paragraph (1)(B) , may not offer coverage in the group market within such service area for a period of 180 days after the date such coverage is denied. A health insurance issuer may deny health insurance coverage in the group if the issuer has demonstrated, if required, to the applicable State authority that— it does not have the financial reserves necessary to underwrite additional coverage; and it is applying this paragraph uniformly to all employers and individuals in the group market in the State— in a manner that is consistent with applicable State law; and without regard to— the claims experience of those individuals, employers, and their employees (and their dependents); or any health-status-related factor relating to such individuals, employees, and dependents. 180- day suspension upon denial of coverage A health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with paragraph
(1)in a State may not offer coverage in connection with group health plans in the group market in the State for a period of 180 days after the date such coverage is denied or until the issuer has demonstrated to the applicable State authority, if required under applicable State law, that the issuer has sufficient financial reserves to underwrite additional coverage, whichever is later. An applicable State authority may provide for the application of this subsection on a service-area-specific basis. . Subpart 1 of part B of title XXVII of the Public Health Service Act is amended by striking section 2741 of such Act ( 42 U.S.C. 300gg–41 ) and inserting the following: The provisions of section 2711 (other than subsection (a)(2) and subsection (b)(3)) shall apply to health insurance coverage offered to individuals by a health insurance issuer in the individual market in the same manner as such provisions apply to health insurance coverage offered to employers by a health insurance issuer in connection with health insurance coverage in the group market. For purposes of this section, the Secretary shall treat any reference of the word employer in such section as a reference to the term individual . .
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- 42 USC 300gg–11
- 42 USC 300gg–41
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Sec. 3
Prohibiting discrimination based on health status
Cite42 USC 300gg–11
Cite42 USC 300gg–41
Cites 2Cited by 0 across 0 sources