§ 300gg–1. Guaranteed availability of coverage
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/usc/title-42/section-300gg-1A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subject to subsections
(b)through (e), 1 each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage. 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 (under section 1163 of title 29 ). The Secretary shall promulgate regulations with respect to enrollment periods under paragraphs
(1)and (2). In the case of a health insurance issuer that offers health insurance coverage in the group and individual market 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 and individuals 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 or any additional individuals because of its obligations to existing group contract holders and enrollees, and it is applying this paragraph uniformly to all employers and individuals 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 1 employees and dependents. An issuer, upon denying health insurance coverage in any service area in accordance with paragraph (1)(B), may not offer coverage in the group or individual 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 or individual market 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 or individual market in the State 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. 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 or individual 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. ( July 1, 1944, ch. 373 , title XXVII, § 2702, as added and amended Pub. L. 111–148, title I , §§ 1201(4), 1563(c)(8), formerly § 1562(c)(8), title X, § 10107(b)(1), Mar. 23, 2010 , 124 Stat. 156 , 266, 911.)
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9 references not yet in our index
- Pub. L. 111-148
- 124 Stat. 156
- Pub. L. 104-191
- 110 Stat. 1962
- 124 Stat. 130
- 110 Stat. 1961
- Pub. L. 110-233
- 122 Stat. 888
- 124 Stat. 154
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§ 300gg–1
Guaranteed availability of coverage
Fed. Reg.×47
Pub. L.Pub. L. 111-148
Stat.124 Stat. 156
Pub. L.Pub. L. 104-191
Stat.110 Stat. 1962
Stat.124 Stat. 130
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