
From the U.S. Code Online via GPO Access
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[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 26USC9832]

 
                     TITLE 26--INTERNAL REVENUE CODE
 
               Subtitle K--Group Health Plan Requirements
 
               CHAPTER 100--GROUP HEALTH PLAN REQUIREMENTS
 
                    Subchapter C--General Provisions
 
Sec. 9832. Definitions


(a) Group health plan

    For purposes of this chapter, the term ``group health plan'' has the 
meaning given to such term by section 5000(b)(1).

(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.

        (B) No application to certain excepted benefits

            In applying subparagraph (A), excepted benefits described in 
        subsection (c)(1) shall not be treated as benefits consisting of 
        medical care.

                     (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))),
            (B) an organization recognized under State law as a health 
        maintenance organization, or
            (C) a similar organization regulated under State law for 
        solvency in the same manner and to the same extent as such a 
        health maintenance organization.

(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

        (A) Coverage only for accident, or disability income insurance, 
    or any combination thereof.
        (B) Coverage issued as a supplement to liability insurance.
        (C) Liability insurance, including general liability insurance 
    and automobile liability insurance.
        (D) Workers' compensation or similar insurance.
        (E) Automobile medical payment insurance.
        (F) Credit-only insurance.
        (G) Coverage for on-site medical clinics.
        (H) Other similar insurance coverage, specified in regulations, 
    under which benefits for medical care are secondary or incidental to 
    other insurance benefits.

        (2) Benefits not subject to requirements if offered 
                                 separately

        (A) Limited scope dental or vision benefits.
        (B) Benefits for long-term care, nursing home care, home health 
    care, community-based care, or any combination thereof.
        (C) Such other similar, limited benefits as are specified in 
    regulations.

       (3) Benefits not subject to requirements if offered as 
                    independent, noncoordinated benefits

        (A) Coverage only for a specified disease or illness.
        (B) Hospital indemnity or other fixed indemnity insurance.

       (4) Benefits not subject to requirements if offered as 
                          separate insurance policy

        Medicare supplemental health insurance (as defined under section 
    1882(g)(1) of the Social Security Act), coverage supplemental to the 
    coverage provided under chapter 55 of title 10, United States Code, 
    and similar supplemental coverage provided to coverage under a group 
    health plan.

(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.
            (C) Title XXII of the Public Health Service Act.

                        (2) Governmental plan

        The term ``governmental plan'' has the meaning given such term 
    by section 414(d).

                          (3) Medical care

        The term ``medical care'' has the meaning given such term by 
    section 213(d) determined without regard to--
            (A) paragraph (1)(C) thereof, and
            (B) so much of paragraph (1)(D) thereof as relates to 
        qualified long-term care insurance.

                          (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.

(Added Pub. L. 104-191, title IV, Sec. 401(a), Aug. 21, 1996, 110 Stat. 
2080; Sec. 9805; renumbered Sec. 9832, Pub. L. 105-34, title XV, 
Sec. 1531(a)(2), Aug. 5, 1997, 111 Stat. 1081.)

                       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 (Sec. 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 (Sec. 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.


                               Amendments

    1997--Pub. L. 105-34 renumbered section 9805 of this title as this 
section.

                  Section Referred to in Other Sections

    This section is referred to in sections 4980D, 9801, 9831 of this 
title; title 29 section 1144a.
