29 U.S.C. § 1191a — Special rules relating to group health plans

(a) General exception for certain small group health plans. The requirements of this part, other than sections 1185 and 1185o, do not apply to a group health plan^*, or to group health insurance coverage^* offered in connection with that plan^*, for a plan year^* if, on the first day of that year, the plan has fewer than 2 participants who are current employees.

(b) Exception for certain benefits. The requirements of this part do not apply to a group health plan, or to group health insurance coverage^*, when the plan or coverage provides the excepted benefits^* described in section 1191b(c)(1).

(c) Exception for certain benefits if conditions are met. (1) Limited, excepted benefits. The requirements of this part do not apply to a group health plan, or to group health insurance coverage offered in connection with that plan, for the plan’s or coverage’s provision of the excepted benefits described in section 1191b(c)(2) if the benefits are provided under a separate insurance policy, certificate, or contract, or are otherwise not an integral part of the plan. (2) Noncoordinated, excepted benefits. The requirements do not apply to a group health plan, or to group health insurance coverage offered in connection with that plan, for the plan’s or coverage’s provision of the excepted benefits described in section 1191b(c)(3) if all of these conditions are met: (A) The benefits are provided under a separate insurance policy, certificate, or contract. (B) Providing these benefits is not coordinated with any exclusion of benefits under any group health plan maintained by the same plan sponsor^*. (C) The benefits are paid for an event without regard to whether any group health plan maintained by the same plan sponsor provides benefits for that event. (3) Supplemental excepted benefits. The requirements do not apply to a group health plan, or to group health insurance coverage, for the plan’s or coverage’s provision of the excepted benefits described in section 1191b(c)(4) if the benefits are provided under a separate insurance policy, certificate, or contract.

(d) Treatment of partnerships. For this part: (1) Treatment as a group health plan. A plan, fund, or program that would not be an employee welfare benefit plan^* but for this subsection, and that is established or maintained by a partnership, is treated as an employee^* welfare benefit plan that is a group health plan to the extent that it provides medical care^*, including items and services paid for as medical care, to current or former partners in the partnership or to their dependents. A “dependent” is defined under the terms of the plan, fund, or program. The care may be provided directly, through insurance, reimbursement, or otherwise. (2) Employer^*. For a group health plan, “employer” also includes the partnership in relation to any partner. (3) Participants of group health plans. For a group health plan, “participant^*” also includes: (A) for a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership; and (B) for a group health plan maintained by a self-employed individual under which one or more employees are participants, the self-employed individual, if that individual is, or may become, eligible to receive a benefit under the plan or that individual’s beneficiaries may be eligible to receive such a benefit. This section does not define “medical care” or the other terms it uses.