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42 U.S.C. § 300gg–23 — Preemption; State flexibility; construction

submitted 82 years ago by Pub. L. 104-191 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 518 words · no verdicts yet

in plain englishAI-generated · not legal advice

Federal rules don't erase stricter state insurance laws, as long as states don't block the federal requirements. For preexisting-condition protections, federal rules override weaker state laws but allow stronger state protections to stand. Nothing here forces a plan to cover specific benefits it wouldn't otherwise cover.

(a) Continued applicability of State law with respect to health insurance issuers. (1) In general. Subject to paragraph (2) and to subsection (b), this part does not override a state law that sets standards solely for health insurance issuers selling individual or group coverage — unless that state standard would block a federal requirement from applying. (2) Continued preemption with respect to group health plans. Nothing here changes section 1144 of title 29 (the ERISA preemption rule) as it applies to group health plans. (b) Special rules in case of portability requirements. (1) In general. Subject to paragraph (2), this part's rules on preexisting-condition exclusions override any state law setting a different standard for preexisting-condition exclusions than section 701 of this title sets. (2) Exceptions. Federal law does not override a state law that, compared to the federal rules: (i) uses a period shorter than 6 months for how far back a preexisting-condition exclusion can look; (ii) uses periods shorter than 12 or 18 months for how long a preexisting-condition exclusion can last; (iii) uses a number of days greater than 63 for counting a break in coverage; (iv) uses a period longer than 30 days for certain notice rules; (v) bans preexisting-condition exclusions in situations the federal law allows them, or adds more exceptions; (vi) requires more special enrollment periods than federal law requires; or (vii) shortens the maximum affiliation period allowed under federal law. In other words, a state can be more protective of consumers, just not less. (c) Rules of construction. Nothing in this part (except for one specific section) requires a group health plan or coverage to offer any specific benefit. (d) Definitions. (1) "State law" means all laws, court decisions, rules, regulations, or other state actions that have the force of law in any state. A District of Columbia law is treated as a state law. (2) "State" includes a state (including the Northern Mariana Islands), its political subdivisions, and any state agency or instrumentality.
the actual law source: uscode.house.gov ↗public domain
(a) Continued applicability of State law with respect to health insurance issuers
(1) In general

Subject to paragraph (2) and except as provided in subsection (b), this part, part D, and part C insofar as it relates to this part or part D shall not be construed to supersede any provision of State law which establishes, implements, or continues in effect any standard or requirement solely relating to health insurance issuers in connection with individual or group health insurance coverage except to the extent that such standard or requirement prevents the application of a requirement of this part or part D.

(2) Continued preemption with respect to group health plans

Nothing in this part or part D shall be construed to affect or modify the provisions of section 1144 of title 29 with respect to group health plans.

(b) Special rules in case of portability requirements
(1) In general

Subject to paragraph (2), the provisions of this part relating to health insurance coverage offered by a health insurance issuer supersede any provision of State law which establishes, implements, or continues in effect a standard or requirement applicable to imposition of a preexisting condition exclusion specifically governed by section 701 1 which differs from the standards or requirements specified in such section.

(2) Exceptions

Only in relation to health insurance coverage offered by a health insurance issuer, the provisions of this part do not supersede any provision of State law to the extent that such provision—

(i)

substitutes for the reference to “6-month period” in section 2701(a)(1) 1 a reference to any shorter period of time;

(ii)

substitutes for the reference to “12 months” and “18 months” in section 2701(a)(2) 1 a reference to any shorter period of time;

(iii)

substitutes for the references to “63” days in sections 2701(c)(2)(A) 1 and 2701(d)(4)(A) 1 a reference to any greater number of days;

(iv)

substitutes for the reference to “30-day period” in sections 2701(b)(2) 1 and 2701(d)(1) 1 a reference to any greater period;

(v)

prohibits the imposition of any preexisting condition exclusion in cases not described in section 2701(d) 1 or expands the exceptions described in such section;

(vi)

requires special enrollment periods in addition to those required under section 2701(f) 1; or

(vii)

reduces the maximum period permitted in an affiliation period under section 2701(g)(1)(B) 1.

(c) Rules of construction

Nothing in this part (other than section 2704) 1 or part D shall be construed as requiring a group health plan or health insurance coverage to provide specific benefits under the terms of such plan or coverage.

(d) Definitions

For purposes of this section—

(1) State law

The term “State law” includes all laws, decisions, rules, regulations, or other State action having the effect of law, of any State. A law of the United States applicable only to the District of Columbia shall be treated as a State law rather than a law of the United States.

(2) State

The term “State” includes a State (including the Northern Mariana Islands), any political subdivisions of a State or such Islands, or any agency or instrumentality of either.

Source credit: (July 1, 1944, ch. 373, title XXVII, § 2724, formerly § 2723, as added Pub. L. 104–191, title I, § 102(a), Aug. 21, 1996, 110 Stat. 1971; amended Pub. L. 104–204, title VI, § 604(b)(2), Sept. 26, 1996, 110 Stat. 2941; renumbered § 2737, renumbered § 2724, and amended Pub. L. 111–148, title I, §§ 1001(4), 1563(c)(14), formerly § 1562(c)(14), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 130, 269, 911; Pub. L. 116–260, div. BB, title I, § 102(a)(3)(D), Dec. 27, 2020, 134 Stat. 2772.)

history & why it existsrecord from the source credit
  • 1944Enacted · Pub. L. 104-191 · 110 Stat. 1971
  • 1996Amended · Pub. L. 104-204 · 110 Stat. 2941
  • 2010Amended · Pub. L. 111-148 · 124 Stat. 130, 269, 911
  • 2020Amended · Pub. L. 116-260 · 134 Stat. 2772

A history note hasn’t been published yet. The record shows enactment by Pub. L. 104-191 on 1944-07-01.

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