§ 18011. Preservation of right to maintain existing coverage

1,228 words·~6 min read·/usc/title-42/section-18011

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(a)No changes to existing coverage

(1)In general Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on March 23, 2010.

(2)Continuation of coverage Except as provided in paragraph (3), with respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after March 23, 2010.

(3)Application of certain provisions The provisions of sections 2715 [42 U.S.C. 300gg–15] and 2718 [42 U.S.C. 300gg–18] of the Public Health Service Act (as added by subtitle A) shall apply to grandfathered health plans for plan years beginning on or after March 23, 2010.

(4)Application of certain provisions

(A)In general The following provisions of the Public Health Service Act [42 U.S.C. 201 et seq.] (as added by this title) 1 shall apply to grandfathered health plans for plan years beginning with the first plan year to which such provisions would otherwise apply:

(i)Section 2708 [42 U.S.C. 300gg–7] (relating to excessive waiting periods).

(ii)Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to lifetime limits.

(iii)Section 2712 [42 U.S.C. 300gg–12] (relating to rescissions).

(iv)Section 2714 [42 U.S.C. 300gg–14] (relating to extension of dependent coverage).

(B)Provisions applicable only to group health plans

(i)Provisions described Those provisions of section 2711 [42 U.S.C. 300gg–11] relating to annual limits and the provisions of section 2704 [42 U.S.C. 300gg–3] (relating to pre-existing condition exclusions) of the Public Health Service Act (as added by this subtitle) shall apply to grandfathered health plans that are group health plans for plan years beginning with the first plan year to which such provisions otherwise apply.

(ii)Adult child coverage For plan years beginning before January 1, 2014, the provisions of section 2714 of the Public Health Service Act [42 U.S.C. 300gg–14] (as added by this subtitle) shall apply in the case of an adult child with respect to a grandfathered health plan that is a group health plan only if such adult child is not eligible to enroll in an eligible employer-sponsored health plan (as defined in section 5000A(f)(2) of title 26) other than such grandfathered health plan.

(5)Application of additional provisions Sections 300gg–111, 300gg–112, and 300gg–117 of this title shall apply to grandfathered health plans for plan years beginning on or after January 1, 2022.

(b)Allowance for family members to join current coverage With respect to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of March 23, 2010.

(c)Allowance for new employees to join current plan A group health plan that provides coverage on March 23, 2010, may provide for the enrolling of new employees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their families).

(d)Effect on collective bargaining agreements In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before March 23, 2010, the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to conform to any requirement added by this subtitle or subtitle A (or amendments) shall not be treated as a termination of such collective bargaining agreement.

(e)Definition In this title,1 the term “grandfathered health plan” means any group health plan or health insurance coverage to which this section applies.

(Pub. L. 111–148, title I, § 1251, title X, § 10103(d), Mar. 23, 2010, 124 Stat. 161, 895; Pub. L. 111–152, title II, § 2301(a), Mar. 30, 2010, 124 Stat. 1081; Pub. L. 116–260, div. BB, title I, § 102(d)(2), Dec. 27, 2020, 134 Stat. 2797.)

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