health plan

(5) Health plan The term “health plan” means an individual or group plan that provides, or pays the cost of, medical care (as such term is defined in section 300gg–91 of this title ). Such term includes the following, and any combination thereof: (A) A group health plan (as defined in section 300gg–91(a) of this title ), but only if the plan— (i) has 50 or more participants (as defined in section 1002(7) of title 29 ); or (ii) is administered by an entity other than the employer who established and maintains the plan. (B) A health insurance issuer (as defined in section 300gg–91(b) of this title ). (C) A health maintenance organization (as defined in section 300gg–91(b) of this title ). (D) Parts A, B, C, or D of the Medicare program under subchapter XVIII. (E) The medicaid program under subchapter XIX. (F) A Medicare supplemental policy (as defined in section 1395ss(g)(1) of this title ). (G) A long-term care policy, including a nursing home fixed indemnity policy (unless the Secretary determines that such a policy does not provide sufficiently comprehensive coverage of a benefit so that the policy should be treated as a health plan). (H) An employee welfare benefit plan or any other arrangement which is established or maintained for the purpose of offering or providing health benefits to the employees of 2 or more employers. (I) The health care program for active military personnel under title 10. (J) The veterans health care program under chapter 17 of title 38. (K) The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), as defined in section 1072(4) of title 10 . (L) The Indian health service program under the Indian Health Care Improvement Act ( 25 U.S.C. 1601 et seq.). (M) The Federal Employees Health Benefit Plan under chapter 89 of title 5.


42 USC § 1320d(5)

Scoping language

For purposes of this part
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