
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 26USC9802]

 
                     TITLE 26--INTERNAL REVENUE CODE
 
               Subtitle K--Group Health Plan Requirements
 
               CHAPTER 100--GROUP HEALTH PLAN REQUIREMENTS
 
    Subchapter A--Requirements Relating to Portability, Access, and 
                              Renewability
 
Sec. 9802. Prohibiting discrimination against individual 
        participants and beneficiaries based on health status
        

(a) In eligibility to enroll

                           (1) In general

        Subject to paragraph (2), a group health plan may not establish 
    rules for eligibility (including continued eligibility) of any 
    individual to enroll under the terms of the plan based on any of the 
    following factors in relation to the individual or a dependent of 
    the individual:
            (A) Health status.
            (B) Medical condition (including both physical and mental 
        illnesses).
            (C) Claims experience.
            (D) Receipt of health care.
            (E) Medical history.
            (F) Genetic information.
            (G) Evidence of insurability (including conditions arising 
        out of acts of domestic violence).
            (H) Disability.

            (2) No application to benefits or exclusions

        To the extent consistent with section 9801, paragraph (1) shall 
    not be construed--
            (A) to require a group health plan to provide particular 
        benefits (or benefits with respect to a specific procedure, 
        treatment, or service) other than those provided under the terms 
        of such plan; or
            (B) to prevent such a plan from establishing limitations or 
        restrictions on the amount, level, extent, or nature of the 
        benefits or coverage for similarly situated individuals enrolled 
        in the plan or coverage.

                          (3) Construction

        For purposes of paragraph (1), rules for eligibility to enroll 
    under a plan include rules defining any applicable waiting periods 
    for such enrollment.

(b) In premium contributions

                           (1) In general

        A group health plan may not require any individual (as a 
    condition of enrollment or continued enrollment under the plan) to 
    pay a premium or contribution which is greater than such premium or 
    contribution for a similarly situated individual enrolled in the 
    plan on the basis of any factor described in subsection (a)(1) in 
    relation to the individual or to an individual enrolled under the 
    plan as a dependent of the individual.

                          (2) Construction

        Nothing in paragraph (1) shall be construed--
            (A) to restrict the amount that an employer may be charged 
        for coverage under a group health plan; or
            (B) to prevent a group health plan from establishing premium 
        discounts or rebates or modifying otherwise applicable 
        copayments or deductibles in return for adherence to programs of 
        health promotion and disease prevention.

(c) Special rules for church plans

    A church plan (as defined in section 414(e)) shall not be treated as 
failing to meet the requirements of this section solely because such 
plan requires evidence of good health for coverage of--
        (1) both any employee of an employer with 10 or less employees 
    (determined without regard to section 414(e)(3)(C)) and any self-
    employed individual, or
        (2) any individual who enrolls after the first 90 days of 
    initial eligibility under the plan.

This subsection shall apply to a plan for any year only if the plan 
included the provisions described in the preceding sentence on July 15, 
1997, and at all times thereafter before the beginning of such year.

(Added Pub. L. 104-191, title IV, Sec. 401(a), Aug. 21, 1996, 110 Stat. 
2078; amended Pub. L. 105-34, title XV, Sec. 1532(a), Aug. 5, 1997, 111 
Stat. 1085.)


                               Amendments

    1997--Subsec. (c). Pub. L. 105-34 added subsec. (c).


                    Effective Date of 1997 Amendment

    Section 1532(b) of Pub. L. 105-34 provided that: ``The amendments 
made by subsection (a) [amending this section] shall take effect as if 
included in the amendments made by section 401(a) of the Health 
Insurance Portability and Accountability Act of 1996 [Pub. L. 104-
191].''

                  Section Referred to in Other Sections

    This section is referred to in section 9803 of this title.
