29 U.S.C. § 1191 | Preemption; State flexibility; construction

(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 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 group health insurance coverage except to the extent that such standard or requirement prevents the application of a requirement of this part.

(2)

Continued preemption with respect to group health plans

section 1144 of this titleNothing in this part shall be construed to affect or modify the provisions of with respect to group health plans.

(b)

Special rules in case of portability requirements

(1)

In general

section 1181 of this titleSubject 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 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—

(A)

section 1181(a)(1) of this title substitutes for the reference to “6-month period” in a reference to any shorter period of time;

(B)

section 1181(a)(2) of this title substitutes for the reference to “12 months” and “18 months” in a reference to any shorter period of time;

(C)

1Section 1181(d)(4) of this title So in original. does not contain subpars.

substitutes for the references to “63 days” in sections 1181(c)(2)(A) and (d)(4)(A)  of this title a reference to any greater number of days;

(D)

2Section 1181(b)(2) of this title So in original. does not refer to a 30-day period.

substitutes for the reference to “30-day period” in sections 1181(b)(2)  and (d)(1) of this title a reference to any greater period;

(E)

section 1181(d) of this title prohibits the imposition of any preexisting condition exclusion in cases not described in or expands the exceptions described in such section;

(F)

section 1181(f) of this title requires special enrollment periods in addition to those required under ; or

(G)

3 So in original. Probably should be “1181(g)(1)(C)”.

reduces the maximum period permitted in an affiliation period under section 1181(g)(1)(B)  of this title.

(c)

Rules of construction

section 1185 of this titleExcept as provided in , nothing in this part 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, the Northern Mariana Islands, any political subdivisions of a State or such Islands, or any agency or instrumentality of either.

Pub. L. 93–406, title I, § 731 Pub. L. 104–191, title I, § 101(a)Aug. 21, 1996110 Stat. 1946 Pub. L. 104–204, title VI, § 603(a)(3)Sept. 26, 1996110 Stat. 2935(, formerly § 704, as added , , ; renumbered § 731 and amended , (b)(1), , , 2937.)

Editorial Notes

Amendments

Pub. L. 104–204, § 603(b)(1)section 1185 of this title1996—Subsec. (c). , substituted “Except as provided in , nothing” for “Nothing”.

Statutory Notes and Related Subsidiaries

Effective Date of 1996 Amendment

Pub. L. 104–204Jan. 1, 1998section 603(c) of Pub. L. 104–204 section 1003 of this titleAmendment by applicable with respect to group health plans for plan years beginning on and after , see , set out as a note under .

Effective Date

June 30, 1997section 101(g) of Pub. L. 104–191 section 1181 of this titleSection applicable with respect to group health plans for plan years beginning after , except as otherwise provided, see , set out as a note under .