
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC300gg-1]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
   SUBCHAPTER XXV--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
 
                      Part A--Group Market Reforms
 
      subpart 1--portability, access, and renewability requirements
 
Sec. 300gg-1. 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, and a health 
    insurance issuer offering group health insurance coverage in 
    connection with 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 
    health status-related 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 300gg \1\ of this title, 
    paragraph (1) shall not be construed--
---------------------------------------------------------------------------
    \1\ See References in Text note below.
---------------------------------------------------------------------------
            (A) to require a group health plan, or group health 
        insurance coverage, to provide particular benefits other than 
        those provided under the terms of such plan or coverage, or
            (B) to prevent such a plan or coverage 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, and a health insurance issuer offering 
    health insurance coverage in connection with 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 health status-related factor 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, and a health insurance 
        issuer offering group health insurance coverage, 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.

(July 1, 1944, ch. 373, title XXVII, Sec. 2702, as added Pub. L. 104-
191, title I, Sec. 102(a), Aug. 21, 1996, 110 Stat. 1961.)

                       References in Text

    Section 300gg of this title, referred to in subsec. (a)(2), was in 
the original ``section 701'' and was translated as reading ``section 
2701'' meaning section 2701 of act July 1, 1944, as added by Pub. L. 
104-191, Sec. 102(a), to reflect the probable intent of Congress.


                            Prior Provisions

    A prior section 2702 of act July 1, 1944, was successively 
renumbered by subsequent acts and transferred, see section 238a of this 
title.


                             Effective Date

    Section applicable with respect to group health plans, and health 
insurance coverage offered in connection with group health plans, for 
plan years beginning after June 30, 1997, except as otherwise provided, 
see section 102(c) of Pub. L. 104-191, set out as a note under section 
300gg of this title.

                  Section Referred to in Other Sections

    This section is referred to in sections 300gg-11, 300gg-91, 1395w-22 
of this title.
