§ 300gg–21. Exclusion of certain plans
3,005 words·~14 min read·
/usc/title-42/section-300gg-21A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The requirements of subparts 1 and 2 1 and part D shall apply with respect to group health plans only— subject to paragraph (2), in the case of a plan that is a nonfederal governmental plan, and 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). 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 2 1 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. An election under subparagraph
(A)shall apply— for a single specified plan year, or 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. Under such an election, the plan shall provide for— 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 certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with section 2701(e). 1 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 1 and the provisions of sections 2701 1 and 2702(b) 1 to the extent that such provisions apply to genetic information. The election described in subparagraph
(A)shall not be available with respect to the provisions of subparts I and II. Notwithstanding the preceding provisions of this paragraph— no election described in subparagraph
(A)with respect to section 300gg–26 of this title may be made on or after December 29, 2022 ; and except as provided in clause (ii), no such election with respect to section 300gg–26 of this title expiring on or after the date that is 180 days after December 29, 2022 , may be renewed. 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 300gg–26 of this title in effect as of December 29, 2022 , that expires on or after the date that is 180 days after December 29, 2022 , may extend such election until the date on which the term of the last such agreement expires. The requirements of subparts 1 and 2 1 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 300gg–91(c)(1) of this title . The requirements of subparts 1 and 2 1 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 300gg–91(c)(2) of this title if the benefits— are provided under a separate policy, certificate, or contract of insurance; or are otherwise not an integral part of the plan. The requirements of subparts 1 and 2 1 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 300gg–91(c)(3) of this title if all of the following conditions are met: The benefits are provided under a separate policy, certificate, or contract of insurance. 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. 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 issuer. 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 300gg–91(c)(4) 1 of this title if the benefits are provided under a separate policy, certificate, or contract of insurance. For purposes of this part and part D— 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. In the case of a group health plan, the term “employer” also includes the partnership in relation to any partner. In the case of a group health plan, the term “participant” also includes— in connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership, or 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. ( July 1, 1944, ch. 373 , title XXVII, § 2722, formerly § 2721, as added Pub. L. 104–191, title I, § 102(a) , Aug. 21, 1996 , 110 Stat. 1967 ; amended Pub. L. 104–204, title VI, § 604(b)(1) , Sept. 26, 1996 , 110 Stat. 2940 ; Pub. L. 110–233, title I, § 102(c) , May 21, 2008 , 122 Stat. 895 ; renumbered § 2735, renumbered § 2722, and amended Pub. L. 111–148, title I , §§ 1001(4), 1563(a), (c)(12), formerly § 1562(a), (c)(12), title X, § 10107(a), (b)(1), Mar. 23, 2010 , 124 Stat. 130 , 264, 268, 911; Pub. L. 116–260, div. BB, title I, § 102(a)(3)(B) , Dec. 27, 2020 , 134 Stat. 2772 ; Pub. L. 117–328, div. FF, title I, § 1321 , Dec. 29, 2022 , 136 Stat. 5697 .)
Connections16 cite this · traces to 2
Cited by 16 sections · top 7
Traces to 2 documents
15 references not yet in our index
- Pub. L. 104-191
- 110 Stat. 1967
- Pub. L. 104-204
- 110 Stat. 2940
- Pub. L. 110-233
- 122 Stat. 895
- Pub. L. 111-148
- 124 Stat. 130
- 134 Stat. 2772
- 136 Stat. 5697
- 124 Stat. 154
- 124 Stat. 155
- 124 Stat. 156
- 122 Stat. 905
- 42 USC 1320d–9
Citation graph
cites case law
§ 300gg–21
Exclusion of certain plans
Fed. Reg.×16
Pub. L.Pub. L. 104-191
Stat.110 Stat. 1967
Pub. L.Pub. L. 104-204
Stat.110 Stat. 2940
Pub. L.Pub. L. 110-233
Cites 17 · showing 7Cited by 16 across 1 source