
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-21]

 
                 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 4--exclusion of plans; enforcement; preemption
 
Sec. 300gg-21. Exclusion of certain plans


(a) Exception for certain small group health plans

    The requirements of subparts 1 and 3 shall not apply to any group 
health plan (and health insurance coverage offered in connection with a 
group health plan) for any plan year if, on the first day of such plan 
year, such plan has less than 2 participants who are current employees.

(b) Limitation on application of provisions relating to group health 
        plans

                           (1) In general

        The requirements of subparts 1 through 3 shall apply with 
    respect to group health plans only--
            (A) subject to paragraph (2), in the case of a plan that is 
        a nonfederal \1\ governmental plan, and
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    \1\ So in original. Probably should be ``non-Federal''.
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            (B) with respect to health insurance coverage offered in 
        connection with a group health plan (including such a plan that 
        is a church plan or a governmental plan).

           (2) Treatment of non-Federal governmental plans

        (A) Election to be excluded

            If the plan sponsor of a nonfederal \1\ governmental plan 
        which is a group health plan to which the provisions of subparts 
        1 through 3 otherwise apply makes an election under this 
        subparagraph (in such form and manner as the Secretary may by 
        regulations prescribe), then the requirements of such subparts 
        insofar as they apply directly to group health plans (and not 
        merely to group health insurance coverage) shall not apply to 
        such governmental plans for such period except as provided in 
        this paragraph.

        (B) Period of election

            An election under subparagraph (A) shall apply--
                (i) for a single specified plan year, or
                (ii) in the case of a plan provided pursuant to a 
            collective bargaining agreement, for the term of such 
            agreement.

        An election under clause (i) may be extended through subsequent 
        elections under this paragraph.

        (C) Notice to enrollees

            Under such an election, the plan shall provide for--
                (i) notice to enrollees (on an annual basis and at the 
            time of enrollment under the plan) of the fact and 
            consequences of such election, and
                (ii) certification and disclosure of creditable coverage 
            under the plan with respect to enrollees in accordance with 
            section 300gg(e) of this title.

(c) Exception for certain benefits

    The requirements of subparts 1 through 3 shall not apply to any 
group health plan (or group health insurance coverage) in relation to 
its provision of excepted benefits described in section 300gg-91(c)(1) 
of this title.

(d) Exception for certain benefits if certain conditions met

                   (1) Limited, excepted benefits

        The requirements of subparts 1 through 3 shall not apply to any 
    group health plan (and group health insurance coverage offered in 
    connection with a group health plan) in relation to its provision of 
    excepted benefits described in section 300gg-91(c)(2) of this title 
    if the benefits--
            (A) are provided under a separate policy, certificate, or 
        contract of insurance; or
            (B) are otherwise not an integral part of the plan.

                (2) Noncoordinated, excepted benefits

        The requirements of subparts 1 through 3 shall not apply to any 
    group health plan (and group health insurance coverage offered in 
    connection with a group health plan) in relation to its provision of 
    excepted benefits described in section 300gg-91(c)(3) of this title 
    if all of the following conditions are met:
            (A) The benefits are provided under a separate policy, 
        certificate, or contract of insurance.
            (B) There is no coordination between the provision of such 
        benefits and any exclusion of benefits under any group health 
        plan maintained by the same plan sponsor.
            (C) Such benefits are paid with respect to an event without 
        regard to whether benefits are provided with respect to such an 
        event under any group health plan maintained by the same plan 
        sponsor.

                 (3) Supplemental excepted benefits

        The requirements of this part shall not apply to any group 
    health plan (and group health insurance coverage) in relation to its 
    provision of excepted benefits described in section 300gg-91(c)(4) 
    \2\ of this title if the benefits are provided under a separate 
    policy, certificate, or contract of insurance.
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    \2\ See References in Text note below.
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(e) Treatment of partnerships

    For purposes of this part--

                (1) Treatment as a group health plan

        Any plan, fund, or program which would not be (but for this 
    subsection) an employee welfare benefit plan and which is 
    established or maintained by a partnership, to the extent that such 
    plan, fund, or program provides medical care (including items and 
    services paid for as medical care) to present or former partners in 
    the partnership or to their dependents (as defined under the terms 
    of the plan, fund, or program), directly or through insurance, 
    reimbursement, or otherwise, shall be treated (subject to paragraph 
    (2)) as an employee welfare benefit plan which is a group health 
    plan.

                            (2) Employer

        In the case of a group health plan, the term ``employer'' also 
    includes the partnership in relation to any partner.

               (3) Participants of group health plans

        In the case of a group health plan, the term ``participant'' 
    also includes--
            (A) in connection with a group health plan maintained by a 
        partnership, an individual who is a partner in relation to the 
        partnership, or
            (B) in connection with a group health plan maintained by a 
        self-employed individual (under which one or more employees are 
        participants), the self-employed individual,

    if such individual is, or may become, eligible to receive a benefit 
    under the plan or such individual's beneficiaries may be eligible to 
    receive any such benefit.

(July 1, 1944, ch. 373, title XXVII, Sec. 2721, as added Pub. L. 104-
191, title I, Sec. 102(a), Aug. 21, 1996, 110 Stat. 1967; amended Pub. 
L. 104-204, title VI, Sec. 604(b)(1), Sept. 26, 1996, 110 Stat. 2940.)

                       References in Text

    Section 300gg-91(c)(4) of this title, referred to in subsec. (d)(3), 
was in the original ``section 27971(c)(4)'' and was translated as 
reading ``section 2791(c)(4)'', meaning section 2791(c)(4) of act July 
1, 1944, as added by Pub. L. 104-191, Sec. 102(a), to reflect the 
probable intent of Congress. Act July 1, 1944, does not contain a 
section 27971.


                               Amendments

    1996--Subsec. (a). Pub. L. 104-204, Sec. 604(b)(1)(A), substituted 
``subparts 1 and 3'' for ``subparts 1 and 2''.
    Subsec. (b) to (d). Pub. L. 104-204, Sec. 604(b)(1)(B), substituted 
``subparts 1 through 3'' for ``subparts 1 and 2'' wherever appearing.


                    Effective Date of 1996 Amendment

    Amendment by Pub. L. 104-204 applicable with respect to group health 
plans for plan years beginning on or after Jan. 1, 1998, see section 
604(c) of Pub. L. 104-204 set out as an Effective Date note under 
section 300gg-4 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.
