42 U.S. Code § 300gg–23 - Preemption; State flexibility; construction

(a) Continued applicability of State law with respect to health insurance issuers
(1) In general
Subject to paragraph (2) and except as provided in subsection (b) of this section, this part and part C of this subchapter insofar as it relates to this part shall not be construed to supersede any provision of State law which establishes, implements, or continues in effect any standard or requirement solely relating to health insurance issuers in connection with individual or group health insurance coverage except to the extent that such standard or requirement prevents the application of a requirement of this part.
(2) Continued preemption with respect to group health plans
Nothing in this part shall be construed to affect or modify the provisions of section 1144 of title 29 with respect to group health plans.
(b) Special rules in case of portability requirements
(1) In general
Subject to paragraph (2), the provisions of this part relating to health insurance coverage offered by a health insurance issuer supersede any provision of State law which establishes, implements, or continues in effect a standard or requirement applicable to imposition of a preexisting condition exclusion specifically governed by section 701  [1] which differs from the standards or requirements specified in such section.
(2) Exceptions
Only in relation to health insurance coverage offered by a health insurance issuer, the provisions of this part do not supersede any provision of State law to the extent that such provision—
(i) substitutes for the reference to “6-month period” in section 2701 (a)(1)  [1] a reference to any shorter period of time;
(ii) substitutes for the reference to “12 months” and “18 months” in section 2701 (a)(2)  [1] a reference to any shorter period of time;
(iii) substitutes for the references to “63” days in sections 2701 (c)(2)(A)  [1] and 2701 (d)(4)(A)  [1] a reference to any greater number of days;
(iv) substitutes for the reference to “30-day period” in sections 2701 (b)(2)  [1] and 2701 (d)(1)  [1] a reference to any greater period;
(v) prohibits the imposition of any preexisting condition exclusion in cases not described in section 2701 (d)  [1] or expands the exceptions described in such section;
(vi) requires special enrollment periods in addition to those required under section 2701 (f)  [1] ; or
(vii) reduces the maximum period permitted in an affiliation period under section 2701 (g)(1)(B)  [1] .
(c) Rules of construction
Nothing in this part (other than section 2704 [1] shall be construed as requiring a group health plan or health insurance coverage to provide specific benefits under the terms of such plan or coverage.
(d) Definitions
For purposes of this section—
(1) State law
The term “State law” includes all laws, decisions, rules, regulations, or other State action having the effect of law, of any State. A law of the United States applicable only to the District of Columbia shall be treated as a State law rather than a law of the United States.
(2) State
The term “State” includes a State (including the Northern Mariana Islands), any political subdivisions of a State or such Islands, or any agency or instrumentality of either.


[1]  See References in Text note below.

Source

(July 1, 1944, ch. 373, title XXVII, § 2724, formerly § 2723, as added Pub. L. 104–191, title I, § 102(a),Aug. 21, 1996, 110 Stat. 1971; amended Pub. L. 104–204, title VI, § 604(b)(2),Sept. 26, 1996, 110 Stat. 2941; renumbered § 2737, renumbered § 2724, and amended Pub. L. 111–148, title I, §§ 1001(4), 1563 (c)(14), formerly § 1562(c)(14), title X, § 10107(b)(1),Mar. 23, 2010, 124 Stat. 130, 269, 911.)
References in Text

Section 2701, referred to in subsec. (b), is a reference to section 2701 of act July 1, 1944. Section 2701, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563 (c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1),Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg–3 of this title. A new section 2701 of act July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a),Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title.
Section 701, referred to in subsec. (b)(1), probably means “section 2701” of act July 1, 1944. See note above.
Section 2704, referred to in subsec. (c), is a reference to section 2704 of act July 1, 1944. Section 2704, which was classified to section 300gg–4 of this title, was renumbered section 2725, and amended by Pub. L. 111–148, title I, §§ 1001(2), 1563 (c)(3), formerly § 1562(c)(3), title X, § 10107(b)(1),Mar. 23, 2010, 124 Stat. 130, 265, 911, and was transferred to section 300gg–25 of this title. A new section 2704 of act July 1, 1944, related to prohibition of preexisting condition exclusions or other discrimination based on health status, was added, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563 (c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1),Mar. 23, 2010, 124 Stat. 154, 264, 911, and is classified to section 300gg–3 of this title.
Amendments

2010—Subsec. (a)(1). Pub. L. 111–148, § 1563(c)(14)(A), formerly § 1562(c)(14)(A), as renumbered by Pub. L. 111–148, § 10107(b)(1), inserted “individual or” before “group health insurance”.
1996—Subsec. (c). Pub. L. 104–204inserted “(other than section 2704)” after “part”.
Effective Date of 1996 Amendment

Amendment by Pub. L. 104–204applicable with respect to group health plans for plan years beginning on or after Jan. 1, 1998, see section 604(c) ofPub. L. 104–204set out as an Effective Date note under section 300gg–25 of this title.
Effective Date

Section applicable with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997, except as otherwise provided, see section 102(c) ofPub. L. 104–191, set out as a note under section 300gg of this title.

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45 CFR - Public Welfare

45 CFR Part 144 - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE

45 CFR Part 146 - REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET

45 CFR Part 148 - REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET

45 CFR Part 150 - CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS

 

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