Fair health insurance premiums
11 So in original. No subsec. (b) has been enacted. Prohibiting discriminatory premium rates
In general
With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
such rate shall vary with respect to the particular plan or coverage involved only by—
whether such plan or coverage covers an individual or family;
rating area, as established in accordance with paragraph (2);
age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 300gg–6(c) of this title); and
tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
Rating area
In general
Secretarial review
Permissible age bands
Application of variations based on age or tobacco use
Special rule for large group market
Source
(July 1, 1944, ch. 373, title XXVII, § 2701, as added and amended Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a),Notes
Prior Provisions
Amendments
Effective Date
section 1251 [enacting section 18011 of this title] shall take effect on the date of enactment of this Act [
the provisions of section 2704 of the Public Health Service Act [42 U.S.C. 300gg–3] (as amended by section 1201), as they apply to enrollees who are under 19 years of age, shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act [
In general.—
Except as provided in this subsection, part A of title XXVII of the Public Health Service Act [42 U.S.C. 300gg et seq.] (as added by subsection (a)) shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after
Determination of creditable coverage.—
Period of coverage.—
In general.—
Subject to clause (ii), no period before
Special rule for certain periods.—
The Secretary of Health and Human Services, consistent with section 104 [42 U.S.C. 300gg–92 note], shall provide for a process whereby individuals who need to establish creditable coverage for periods before
Certifications, etc.—
In general.—
Subject to clauses (ii) and (iii), subsection (e) of section 2701 [now 2704] of the Public Health Service Act [42 U.S.C. 300gg–3(e)] (as added by this section) shall apply to events occurring after
No certification required to be provided before june 1, 1997.—
In no case is a certification required to be provided under such subsection before
Certification only on written request for events occurring before october 1, 1996.—
In the case of an event occurring after
Transitional rule.—
In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before
the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and
a group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under the amendments made by this section [enacting this section and sections 300gg–1, 300gg–11 to 300gg–13, 300gg–21 to 300gg–23, 300gg–91, and 300gg–92 of this title and amending sections 300e and 300bb–8 of this title].
Special rule for collective bargaining agreements.—
Except as provided in paragraph (2)(B), in the case of a group health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act [
the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or
For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of such part shall not be treated as a termination of such collective bargaining agreement.
Timely regulations.—
The Secretary of Health and Human Services, consistent with section 104 [42 U.S.C. 300gg–92 note], shall first issue by not later than
Limitation on actions.—
No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before
Congressional Findings Relating to Exercise of Commerce Clause Authority; Severability
Findings Relating to Exercise of Commerce Clause Authority.—
Congress finds the following in relation to the provisions of this title [enacting this subchapter and sections 1181 to 1183 and 1191 to 1191c of Title 29, Labor, amending sections 233, 300e, and 300bb–8 of this title and sections 1003, 1021, 1022, 1024, 1132, 1136, and 1144 of Title 29, and enacting provisions set out as notes under this section, section 300gg–92 of this title, and section 1181 of Title 29]:
Provisions in group health plans and health insurance coverage that impose certain preexisting condition exclusions impact the ability of employees to seek employment in interstate commerce, thereby impeding such commerce.
Health insurance coverage is commercial in nature and is in and affects interstate commerce.
It is a necessary and proper exercise of Congressional authority to impose requirements under this title on group health plans and health insurance coverage (including coverage offered to individuals previously covered under group health plans) in order to promote commerce among the States.
Congress, however, intends to defer to States, to the maximum extent practicable, in carrying out such requirements with respect to insurers and health maintenance organizations that are subject to State regulation, consistent with the provisions of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1001 et seq.].
Severability.—
If any provision of this title or the application of such provision to any person or circumstance is held to be unconstitutional, the remainder of this title and the application of the provisions of such to any person or circumstance shall not be affected thereby.”