US Code

Public Law 119-73 (01/23/2026)

29 U.S.C. § 1191b

Definitions

(a)

Group health plan

For purposes of this part—
(1)

In general

section 9831(d)(2) of title 26The term “group health plan” means an employee welfare benefit plan to the extent that the plan provides medical care (as defined in paragraph (2) and including items and services paid for as medical care) to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Such term shall not include any qualified small employer health reimbursement arrangement (as defined in ).

(2)

Medical care

The term “medical care” means amounts paid for—
(A)
the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body,
(B)
amounts paid for transportation primarily for and essential to medical care referred to in subparagraph (A), and
(C)
amounts paid for insurance covering medical care referred to in subparagraphs (A) and (B).
(b)

Definitions relating to health insurance

For purposes of this part—
(1)

Health insurance coverage

The term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.

(2)

Health insurance issuer

section 1144(b)(2) of this titleThe term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of ). Such term does not include a group health plan.

(3)

Health maintenance organization

The term “health maintenance organization” means—
(A)
42 U.S.C. 300e(a) a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act ()),
(B)
an organization recognized under State law as a health maintenance organization, or
(C)
a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization.
(4)

Group health insurance coverage

The term “group health insurance coverage” means, in connection with a group health plan, health insurance coverage offered in connection with such plan.

(c)

Excepted benefits

For purposes of this part, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:
(1)

Benefits not subject to requirements

(A)
Coverage only for accident, or disability income insurance, or any combination thereof.
(B)
Coverage issued as a supplement to liability insurance.
(C)
Liability insurance, including general liability insurance and automobile liability insurance.
(D)
Workers’ compensation or similar insurance.
(E)
Automobile medical payment insurance.
(F)
Credit-only insurance.
(G)
Coverage for on-site medical clinics.
(H)
Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
(2)

Benefits not subject to requirements if offered separately

(A)
Limited scope dental or vision benefits.
(B)
Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
(C)
Such other similar, limited benefits as are specified in regulations.
(3)

Benefits not subject to requirements if offered as independent, noncoordinated benefits

(A)
Coverage only for a specified disease or illness.
(B)
Hospital indemnity or other fixed indemnity insurance.
(4)

Benefits not subject to requirements if offered as separate insurance policy

section 1395ss(g)(1) of title 42Medicare supplemental health insurance (as defined under ), coverage supplemental to the coverage provided under chapter 55 of title 10, and similar supplemental coverage provided to coverage under a group health plan.

(d)

Other definitions

For purposes of this part—
(1)

COBRA continuation provision

The term “COBRA continuation provision” means any of the following:
(A)
Part 6 of this subtitle.
(B)
Section 4980B of title 26 , other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines.
(C)
42 U.S.C. 300bb–1 Title XXII of the Public Health Service Act [ et seq.].
(2)

Health status-related factor

section 1182(a)(1) of this titleThe term “health status-related factor” means any of the factors described in .

(3)

Network plan

The term “network plan” means health insurance coverage offered by a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, in whole or in part, through a defined set of providers under contract with the issuer.

(4)

Placed for adoption

section 1169(c)(3)(B) of this titleThe term “placement”, or being “placed”, for adoption, has the meaning given such term in .

(5)

Family member

The term “family member” means, with respect to an individual—
(A)
section 1181(f)(2) of this title a dependent (as such term is used for purposes of ) of such individual, and
(B)
any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual or of an individual described in subparagraph (A).
(6)

Genetic information

(A)

In general

The term “genetic information” means, with respect to any individual, information about—
(i)
such individual’s genetic tests,
(ii)
the genetic tests of family members of such individual, and
(iii)
the manifestation of a disease or disorder in family members of such individual.
(B)

Inclusion of genetic services and participation in genetic research

Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.

(C)

Exclusions

The term “genetic information” shall not include information about the sex or age of any individual.

(7)

Genetic test

(A)

In general

The term “genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.

(B)

Exceptions

The term “genetic test” does not mean—
(i)
an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or
(ii)
an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.
(8)

Genetic services

The term “genetic services” means—
(A)
a genetic test;
(B)
genetic counseling (including obtaining, interpreting, or assessing genetic information); or
(C)
genetic education.
(9)

Underwriting purposes

The term “underwriting purposes” means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan—
(A)
rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage;
(B)
the computation of premium or contribution amounts under the plan or coverage;
(C)
the application of any pre-existing condition exclusion under the plan or coverage; and
(D)
other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.

Pub. L. 93–406, title I, § 733Pub. L. 104–191, title I, § 101(a)110 Stat. 1949Pub. L. 104–204, title VI, § 603(a)(3)110 Stat. 2935Pub. L. 110–233, title I, § 101(d)122 Stat. 885Pub. L. 114–255, div. C, title XVIII, § 18001(b)(1)130 Stat. 1343(, formerly § 706, as added , , ; renumbered § 733, , , ; amended , , ; , , .)

Editorial Notes

References in Text

act July 1, 1944, ch. 37358 Stat. 682section 201 of Title 42The Public Health Service Act, referred to in subsec. (d)(1)(C), is , . Title XXII of the Act is classified generally to subchapter XX (§ 300bb–1 et seq.) of chapter 6A of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under and Tables.

Amendments

Pub. L. 114–255section 9831(d)(2) of title 262016—Subsec. (a)(1). inserted at end “Such term shall not include any qualified small employer health reimbursement arrangement (as defined in ).”

Pub. L. 110–2332008—Subsec. (d)(5) to (9). added pars. (5) to (9).

Statutory Notes and Related Subsidiaries

Effective Date of 2016 Amendment

Pub. L. 114–255section 18001(b)(3) of Pub. L. 114–255section 1167 of this titleAmendment by applicable to plan years beginning after , see , set out as a note under .

Effective Date of 2008 Amendment

Pub. L. 110–233section 101(f)(2) of Pub. L. 110–233section 1132 of this titleAmendment by applicable with respect to group health plans for plan years beginning after the date that is one year after , see , set out as a note under .

Effective Date

section 101(g) of Pub. L. 104–191section 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 .