42 U.S.C. § 300gg–1 — Guaranteed availability of coverage

(a) Guaranteed issuance of coverage in the individual and group market Subject to subsections (b) through (e), every health insurer selling individual or group health insurance in a state must accept every employer and individual in that state who applies for coverage. (b) Enrollment (1) Restriction: An insurer may limit enrollment in this coverage to open enrollment periods or special enrollment periods. (2) Establishment: The insurer must set up special enrollment periods for "qualifying events" under section 1163 of title 29, following regulations made under paragraph (3). (3) Regulations: The Secretary must issue regulations covering these enrollment periods. (c) Special rules for network plans (1) In general: An insurer selling coverage through a network plan may: (A) Limit which employers can apply to those whose eligible employees live, work, or reside in the plan's service area; and (B) Within that service area, deny coverage to employers and individuals if the insurer shows the state's insurance authority, when required, that: (i) It lacks the capacity to serve any more enrollees because of its existing commitments to current group contract holders and enrollees, and (ii) It applies this denial the same way to all employers and individuals, without regard to anyone's health history or health status. (2) 180-day suspension upon denial of coverage: After denying coverage this way in a service area, the insurer cannot sell group or individual coverage in that service area for 180 days. (d) Application of financial capacity limits (1) In general: An insurer may deny coverage in the group or individual market if it shows the state authority, when required, that: (A) It does not have enough financial reserves to underwrite more coverage; and (B) It applies this denial the same way to everyone in the group or individual market in the state, following state law and without regard to anyone's health history or health status. (2) 180-day suspension upon denial of coverage: After denying coverage this way for group health plans, the insurer cannot sell group or individual coverage in that state for 180 days after the denial — or until it shows the state authority, if state law requires it, that it now has enough reserves to underwrite more coverage, whichever comes later. A state authority may apply this rule separately for each service area.