26 U.S. Code § 9832 - Definitions
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(a) Group health plan
(b) Definitions relating to health insurance
For purposes of this chapter—
(1) Health insurance coverage
(A) In general
Except as provided in subparagraph (B), the term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.
(2) Health insurance issuer
The term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section). Such term does not include a group health plan.
(3) Health maintenance organization
The term “health maintenance organization” means—
(A) a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act (42 U.S.C. 300e (a))),
(c) Excepted benefits
For purposes of this chapter, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:
(1) Benefits not subject to requirements
(2) Benefits not subject to requirements if offered separately
(B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
(3) Benefits not subject to requirements if offered as independent, noncoordinated benefits
(4) Benefits not subject to requirements if offered as separate insurance policy
(d) Other definitions
For purposes of this chapter—
(1) COBRA continuation provision
The term “COBRA continuation provision” means any of the following:
(A) Section 4980B, other than subsection (f)(1) thereof insofar as it relates to pediatric vaccines.
(B) Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.), other than section 609 of such Act.
(2) Governmental plan
(3) Medical care
The term “medical care” has the meaning given such term by section 213 (d) determined without regard to—
(4) Network plan
The term “network plan” means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the issuer.
(5) Placed for adoption defined
The term “placement”, or being “placed”, for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child’s placement with such person terminates upon the termination of such legal obligation.
(6) Family member
The term “family member” means, with respect to any individual—
(7) Genetic information
(A) In general
The term “genetic information” means, with respect to any individual, information about—
(B) Inclusion of genetic services and participation in genetic research
Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.
(8) Genetic test
(A) In general
The term “genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.
The term “genetic test” does not mean—
(i) an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or
(9) Genetic services
The term “genetic services” means—
(10) Underwriting purposes
The term “underwriting purposes” means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan—
(A) rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage;
Source(Added Pub. L. 104–191, title IV, § 401(a),Aug. 21, 1996, 110 Stat. 2080, § 9805; renumbered § 9832,Pub. L. 105–34, title XV, § 1531(a)(2),Aug. 5, 1997, 111 Stat. 1081; amended Pub. L. 110–233, title I, § 103(d),May 21, 2008, 122 Stat. 898.)
References in Text
The Employee Retirement Income Security Act of 1974, referred to in subsecs. (b)(2) and (d)(1)(B), is Pub. L. 93–406, Sept. 2, 1974, 88 Stat. 832, as amended. Section 514(b)(2) of the Act is classified to section 1144 (b)(2) of Title 29, Labor. Section 609 of the Act is classified to section 1169 of Title 29. Part 6 of subtitle B of title I of the Act is classified generally to part 6 (§ 1161 et seq.) of subtitle B of subchapter I of chapter 18 of Title 29. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of Title 29 and Tables.
The date of the enactment of this section, referred to in subsec. (b)(2), is the date of enactment of Pub. L. 104–191, which was approved Aug. 21, 1996.
Section 1882(g)(1) of the Social Security Act, referred to in subsec. (c)(4), is classified to section 1395ss (g)(1) of Title 42, The Public Health and Welfare.
The Public Health Service Act, referred to in subsec. (d)(1)(C), is act July 1, 1944, ch. 373, 58 Stat. 682, as amended. Title XXII of the Act is classified generally to subchapter XX (§ 300bb–1 et seq.) of chapter 6A of Title 42. For complete classification of this Act to the Code, see Short Title note set out under section 201 of Title 42 and Tables.
2008—Subsec. (d)(6) to (10). Pub. L. 110–233added pars. (6) to (10).
Effective Date of 2008 Amendment