29 U.S.C. § 1164 — Applicable premium
submitted 40 years ago by Pub. L. 93-406 to r/title-29-LABOR · 345 words · no verdicts yet
This section addresses applicable premium. It states the specific duties, permissions, limits, exceptions, and other rules set out in the section.
For purposes of this part—
(1) In general The term “applicable premium” means, about any period of continuation coverage of qualified beneficiaries, the cost to the plan* for such period of the coverage for similarly situated beneficiaries about whom a qualifying event* has not occurred (without regard to whether such cost is paid by the employer* or employee*).
(2) Special rule for self-insured plans To the extent that a plan is a self-insured plan—
(A) In general Except as provided in subparagraph (B), the applicable premium for any period of continuation coverage of qualified beneficiaries must be equal to a reasonable estimate of the cost of providing coverage for such period for similarly situated beneficiaries which—
(i) is determined on an actuarial basis, and
(ii) takes into account such factors as the Secretary* may prescribe in regulations.
(B) Determination on basis of past cost If an administrator* elects to have this subparagraph apply, the applicable premium for any period of continuation coverage of qualified beneficiaries must be equal to—
(i) the cost to the plan for similarly situated beneficiaries for the same period occurring during the preceding determination period under paragraph (3), adjusted by
(ii) the percentage increase or decrease in the implicit price deflator of the gross national product (calculated by the Department of Commerce* and published in the Survey of Current Business) for the 12-month period ending on the last day of the sixth month of such preceding determination period.
(C) Subparagraph
(B) not to apply where significant change An administrator cannot elect to have subparagraph
(B) apply in any case in which there is any significant difference, between the determination period and the preceding determination period, in coverage under, or in employees covered by, the plan. The determination under the preceding sentence for any determination period must be made at the same time as the determination under paragraph (3).
(3) Determination period The determination of any applicable premium must be made for a period of 12 months and must be made before the beginning of such period.
For purposes of this part—
The term “applicable premium” means, with respect to any period of continuation coverage of qualified beneficiaries, the cost to the plan* for such period of the coverage for similarly situated beneficiaries with respect to whom a qualifying event* has not occurred (without regard to whether such cost is paid by the employer* or employee*).
To the extent that a plan is a self-insured plan—
Except as provided in subparagraph (B), the applicable premium for any period of continuation coverage of qualified beneficiaries shall be equal to a reasonable estimate of the cost of providing coverage for such period for similarly situated beneficiaries which—
is determined on an actuarial basis, and
takes into account such factors as the Secretary* may prescribe in regulations.
If an administrator* elects to have this subparagraph apply, the applicable premium for any period of continuation coverage of qualified beneficiaries shall be equal to—
the cost to the plan for similarly situated beneficiaries for the same period occurring during the preceding determination period under paragraph (3), adjusted by
the percentage increase or decrease in the implicit price deflator of the gross national product (calculated by the Department of Commerce* and published in the Survey of Current Business) for the 12-month period ending on the last day of the sixth month of such preceding determination period.
An administrator may not elect to have subparagraph (B) apply in any case in which there is any significant difference, between the determination period and the preceding determination period, in coverage under, or in employees covered by, the plan. The determination under the preceding sentence for any determination period shall be made at the same time as the determination under paragraph (3).
The determination of any applicable premium shall be made for a period of 12 months and shall be made before the beginning of such period.
Source credit: (Pub. L. 93–406, title I, § 604, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 229.)
- 1986Enacted · Pub. L. 93-406 · 100 Stat. 229
A history note hasn’t been published yet. The record shows enactment by Pub. L. 93-406 on 1986-04-07.
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