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§9815 — Additional market reforms

Statute Text — 26 U.S.C. §9815

(a)General rule

Except as provided in subsection (b)—

(1)

the provisions of part A of title XXVII of the Public Health Service Act (as amended by the Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subchapter; and

(2)

to the extent that any provision of this subchapter conflicts with a provision of such part A with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such part A shall apply.

(b)Exception

Notwithstanding subsection (a), the provisions of sections 2716 and 2718 of title XXVII of the Public Health Service Act (as amended by the Patient Protection and Affordable Care Act) shall not apply with respect to self-insured group health plans, and the provisions of this subchapter shall continue to apply to such plans as if such sections of the Public Health Service Act (as so amended) had not been enacted.

Treasury Regulations

  • Treas. Reg. §Treas. Reg. §54.9815-1251 Preservation of right to maintain existing coverage
  • Treas. Reg. §Treas. Reg. §54.9815-1251(a) Definition of grandfathered health plan coverage—(1) In general—(i) Grandfathered health plan coverage means coverage provided by a group health plan, or a health insurance issuer, in which an individual was enrolled on March 23, 2010 (for as long as it maintains that status under the rules of this section).
  • Treas. Reg. §Treas. Reg. §54.9815-1251(b) Allowance for new employees to join current plan— (1) In general.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(c) General grandfathering rule—(1) Except as provided in paragraphs (d) and (e) of this section, subtitles A and C of title I of the Patient Protection and Affordable Care Act (and the amendments made by those subtitles, and the incorporation of those amendments into ERISA section 715 and Internal Revenue Code section 9815) do not apply to grandfathered health plan coverage.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(d) Provisions applicable to all grandfathered health plans.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(e) Applicability of PHS Act sections 2704, 2711, and 2714 to grandfathered group health plans and group health insurance coverage—(1) The provisions of PHS Act section 2704 as it applies with respect to enrollees who are under 19 years of age, and the provisions of PHS Act section 2711 insofar as it relates to annual dollar limits, apply to grandfathered health plans that are group health plans (including group health insurance coverage) for plan years beginning on or after September 23, 2010.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(f) Effect on collectively bargained plans—In general.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(g) Maintenance of grandfather status—(1) Changes causing cessation of grandfather status.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(i) Elimination of benefits.
  • Treas. Reg. §Treas. Reg. §54.9815-1251(v) Decrease in contribution rate by employers and employee organizations—(A) Contribution rate based on cost of coverage.
  • Treas. Reg. §Treas. Reg. §54.9815-2704 Prohibition of preexisting condition exclusions
  • Treas. Reg. §Treas. Reg. §54.9815-2704(a) No preexisting condition exclusions.
  • Treas. Reg. §Treas. Reg. §54.9815-2704(b) Examples.
  • Treas. Reg. §Treas. Reg. §54.9815-2704(c) Applicability date.
  • Treas. Reg. §Treas. Reg. §54.9815-2705 Prohibiting discrimination against participants and beneficiaries based on a health factor
  • Treas. Reg. §Treas. Reg. §54.9815-2705(a) In general.
  • Treas. Reg. §Treas. Reg. §54.9815-2705(b) Applicability date.
  • Treas. Reg. §Treas. Reg. §54.9815-2708 Prohibition on waiting periods that exceed 90 days
  • Treas. Reg. §Treas. Reg. §54.9815-2708(a) General rule.
  • Treas. Reg. §Treas. Reg. §54.9815-2708(b) Waiting period defined.
  • Treas. Reg. §Treas. Reg. §54.9815-2708(c) Relation to a plan's eligibility criteria—(1) In general.
  • Treas. Reg. §Treas. Reg. §54.9815-2708(d) Application to rehires.
  • Treas. Reg. §Treas. Reg. §54.9815-2708(e) Counting days.
  • Treas. Reg. §Treas. Reg. §54.9815-2708(f) Examples.
  • Treas. Reg. §Treas. Reg. §54.9815-2708(g) Special rule for health insurance issuers.

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