Sec. 2722.15. EXCLUSION OF CERTAIN PLANS
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## SEC. 2722.15 EXCLUSION OF CERTAIN PLANS **[**300gg–21**]** ###
(a)Limitation on Application of Provisions Relating to Group Health Plans 15The numerical sequence of section enumerators beginning in subpart 2 so in law. See section enumerators at the end of subpart 1 of this part and amendments redesignating section enumerators in subpart 2 by section 1001(4) and section 1563(c)(12) of Public Law 111–148. See footnote accompanying section 2725 regarding ambiguity in placement of sections 2725–2728. There are conflicting amendments made to provisions of this section by section 1563(a) and section 1563(c)(12)(B) (relating to conforming amendments—originally designated as section 1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148). The amendments reflected here are from section 1563(a) of such Public Law and thereby renders the global amendment made by subsection (c)(12)(B) unexecutable. ####
(1)In general The requirements of subparts 1 and 216 and part D shall apply with respect to group health plans only— 16The references to “subparts 1 and 2” probably should read “subparts I and II”. #####
(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 nonfederal governmental plans #####
(A)Election to be excluded Except as provided in subparagraph
(D)or (E), if the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of subparts 1 and 216 otherwise apply makes an election under this subparagraph (in such form and manner as the Secretary may by regulations prescribe), then the requirements of such subparts insofar as they apply directly to group health plans (and not merely to group health insurance coverage) shall not apply to such governmental plans for such period except as provided in this paragraph. #####
(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). #####
(D)Election not applicable to requirements concerning genetic information The election described in subparagraph
(A)shall not be available with respect to the provisions of subsections (a)(1)(F), (b)(3), (c), and
(d)of section 2702 and the provisions of sections 2701 and 2702(b) to the extent that such provisions apply to genetic information. #####
(E)Election not applicable The election described in subparagraph
(A)shall not be available with respect to the provisions of subparts I and II. #####
(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 2726 may be made on or after the date of the enactment of this subparagraph; and ######
(II)except as provided in clause (ii), no such election with respect to section 2726 expiring on or after the date that is 180 days after the date of such enactment may be renewed. ######
(ii)Exception for certain collectively bargained plans Notwithstanding clause (i)(II), a plan described in subparagraph (B)(ii) that is subject to multiple agreements described in such subparagraph of varying lengths and that has an election described in subparagraph
(A)with respect to section 2726 in effect as of the date of the enactment of this subparagraph that expires on or after the date that is 180 days after the date of such enactment may extend such election until the date on which the term of the last such agreement expires. ###
(b)Exception for Certain Benefits The requirements of subparts 1 and 217 and part D shall not apply to any individual coverage or any group health plan (or group health insurance coverage) in relation to its provision of excepted benefits described in section 2791(c)(1). 17The references to “subparts 1 and 2” probably should read “subparts I and II”. ###
(c)Exception for Certain Benefits If Certain Conditions Met ####
(1)Limited, excepted benefits The requirements of subparts 1 and 217 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 2791(c)(2) 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 subparts 1 and 217 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 2791(c)(3) 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 or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer18. 18Section 1563 (relating to conforming amendments--originally designated as section 1562 and redesignated as section 1563 by section 10107(b)(1)) of Public Law 111–148 provides for an amendment to insert “or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer”. Such amendment did not specify where to insert this new language, however, it was carried out by inserting this new language before the period at the end in order to reflect the probable intent of Congress. ####
(3)Supplemental excepted benefits The requirements of this part and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in section 27971(c)(4) if the benefits are provided under a separate policy, certificate, or contract of insurance. ###
(d)Treatment of Partnerships For purposes of this part and part D— ####
(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.
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Sec. 2722.15
EXCLUSION OF CERTAIN PLANS
Pub. L.Pub. L. 111-148
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