42 U.S.C. § 300gg–21 — Exclusion of certain plans

(a) Limitation on application of provisions relating to group health plans. (1) In general. The requirements in this part generally apply to group health plans only (A) for a nonfederal governmental plan, subject to paragraph (2), and (B) for health insurance coverage sold in connection with a group plan (including a church or governmental plan). (2) Treatment of non-federal governmental plans. (A) Election to be excluded. Except as (D) and (E) say, the sponsor of a nonfederal governmental group plan can elect (in a form the Secretary sets by regulation) to exempt the plan from requirements that apply directly to plans (not just to the insurance coverage), for a limited time. (B) Period of election. This election lasts either (i) for one specified plan year, or (ii) for the term of a collective bargaining agreement. A plan-year election can be renewed through later elections. (C) Notice to enrollees. Under this election, the plan must (i) tell enrollees, every year and at enrollment, about the election and what it means, and (ii) still certify and disclose creditable coverage as required. (D) Election not applicable to genetic information requirements. A plan cannot use this election to avoid the genetic-information protections in the relevant nondiscrimination provisions. (E) Election not applicable. The election is also unavailable for certain other listed provisions. (F) Sunset of election option. (i) No new election covering section 300gg–26 of this title can be made on or after December 29, 2022, and — except for the exception below — no such election expiring on or after 180 days after that date can be renewed. (ii) A collectively bargained plan under multiple agreements of different lengths, with a section 300gg–26 election in effect as of December 29, 2022 that expires on or after 180 days after that date, may extend the election until its last agreement's term ends. (b) Exception for certain benefits. This part's requirements do not apply to coverage or a group plan's provision of the "excepted benefits" described in section 300gg–91(c)(1) of this title. (c) Exception for certain benefits if certain conditions are met. (1) Limited excepted benefits. These requirements don't apply to the excepted benefits described in section 300gg–91(c)(2) of this title if the benefits (A) are provided under a separate policy or contract, or (B) are not otherwise an integral part of the plan. (2) Noncoordinated excepted benefits. These requirements don't apply to the excepted benefits described in section 300gg–91(c)(3) of this title if: (A) they're provided under a separate policy; (B) they aren't coordinated with any exclusion under a group plan from the same sponsor; and (C) they're paid regardless of whether a group plan from the same sponsor (or, for individual coverage, the same issuer) also covers the same event. (3) Supplemental excepted benefits. These requirements don't apply to the excepted benefits described in section 300gg–91(c)(4) of this title if they're provided under a separate policy. (d) Treatment of partnerships. For this part: (1) A plan, fund, or program that a partnership sets up to give medical care to its partners, former partners, or their dependents is treated as a group health plan, even if it wouldn't otherwise count as one. (2) "Employer" for a group plan also includes the partnership itself, as to any partner. (3) "Participant" for a group plan also includes (A) a partner in a plan the partnership maintains, or (B) a self-employed person who maintains a plan covering their employees, if that person is or may become eligible for a benefit, and their beneficiaries.