No changes to existing coverage
In general
Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on .
Continuation of coverage
Except as provided in paragraph (3), with respect to a group health plan or health insurance coverage in which an individual was enrolled on , this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply to such plan or coverage, regardless of whether the individual renews such coverage after .
Application of certain provisions
42 U.S.C. 300gg–1542 U.S.C. 300gg–18The provisions of sections 2715 [] and 2718 [] of the Public Health Service Act (as added by subtitle A) shall apply to grandfathered health plans for plan years beginning on or after .
Application of certain provisions
In general
Provisions applicable only to group health plans
Provisions described
42 U.S.C. 300gg–1142 U.S.C. 300gg–3Those provisions of section 2711 [] relating to annual limits and the provisions of section 2704 [] (relating to pre-existing condition exclusions) of the Public Health Service Act (as added by this subtitle) shall apply to grandfathered health plans that are group health plans for plan years beginning with the first plan year to which such provisions otherwise apply.
Adult child coverage
42 U.S.C. 300gg–14section 5000A(f)(2) of title 26For plan years beginning before , the provisions of section 2714 of the Public Health Service Act [] (as added by this subtitle) shall apply in the case of an adult child with respect to a grandfathered health plan that is a group health plan only if such adult child is not eligible to enroll in an eligible employer-sponsored health plan (as defined in ) other than such grandfathered health plan.
Application of additional provisions
Sections 300gg–111, 300gg–112, and 300gg–117 of this title shall apply to grandfathered health plans for plan years beginning on or after .
Allowance for family members to join current coverage
With respect to a group health plan or health insurance coverage in which an individual was enrolled on , and which is renewed after such date, family members of such individual shall be permitted to enroll in such plan or coverage if such enrollment is permitted under the terms of the plan in effect as of .
Allowance for new employees to join current plan
A group health plan that provides coverage on , may provide for the enrolling of new employees (and their families) in such plan, and this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply with respect to such plan and such new employees (and their families).
Effect on collective bargaining agreements
In the case of health insurance coverage maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers that was ratified before , the provisions of this subtitle and subtitle A (and the amendments made by such subtitles) shall not apply until the date on which the last of the collective bargaining agreements relating to the coverage terminates. Any coverage amendment made pursuant to a collective bargaining agreement relating to the coverage which amends the coverage solely to conform to any requirement added by this subtitle or subtitle A (or amendments) shall not be treated as a termination of such collective bargaining agreement.
Definition
1In this title, the term “grandfathered health plan” means any group health plan or health insurance coverage to which this section applies.
Pub. L. 111–148, title I, § 1251124 Stat. 161Pub. L. 111–152, title II, § 2301(a)124 Stat. 1081Pub. L. 116–260, div. BB, title I, § 102(d)(2)134 Stat. 2797(, title X, § 10103(d), , , 895; , , ; , , .)
Editorial Notes
References in Text
Pub. L. 111–148124 Stat. 119section 18001 of this titleThis Act, referred to in subsec. (a)(1), is , , , known as the Patient Protection and Affordable Care Act. For complete classification of this Act to the Code, see Short Title note set out under and Tables.
Pub. L. 111–148124 Stat. 154section 300gg of this titlesection 300gg–3 of this titlesection 300gg of this titleThis subtitle, referred to in subsecs. (a)(2), (4)(B), (c), and (d), is subtitle C (§§ 1201–1255) of title I of , , , which enacted this subchapter and sections 300gg to 300gg–2 and 300gg–4 to 300gg–7 of this title, transferred to , amended sections 300gg–1 and 300gg–4 of this title, and enacted provisions set out as a note under . For complete classification of subtitle C to the Code, see Tables.
Pub. L. 111–148124 Stat. 130section 300gg–11 of this titleSubtitle A, referred to in subsecs. (a)(2), (3), (c), and (d), is subtitle A (§§ 1001–1004) of title I of , , , which enacted sections 300gg–11 to 300gg–19, 300gg–93, and 300gg–94 of this title, transferred sections 300gg–4 to 300gg–7 and 300gg–13 of this title to sections 300gg–25 to 300gg–28 and 300gg–9 of this title, respectively, amended sections 300gg–11, 300gg–12, and 300gg–21 to 300gg–23 of this title, and enacted provisions set out as a note under . For complete classification of subtitle A to the Code, see Tables.
act July 1, 1944, ch. 37358 Stat. 682section 201 of this titleThe Public Health Service Act, referred to in subsec. (a)(4)(A), is , , which is classified generally to chapter 6A (§ 201 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under and Tables.
Pub. L. 111–148124 Stat. 130This title, referred to in subsecs. (a)(4)(A) and (e), is title I of , , , which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.
Amendments
Pub. L. 116–2602020—Subsec. (a)(5). added par. (5).
Pub. L. 111–148, § 10103(d)(1)2010—Subsec. (a)(2). , substituted “Except as provided in paragraph (3), with” for “With”.
Pub. L. 111–148, § 10103(d)(2)Subsec. (a)(3). , added par. (3).
Pub. L. 111–152Subsec. (a)(4). added par. (4).
Statutory Notes and Related Subsidiaries
Effective Date of 2020 Amendment
Pub. L. 116–260section 102(e) of div. BB of Pub. L. 116–260section 8902 of Title 5Amendment by applicable with respect to plan years beginning on or after , see , set out as a note under , Government Organization and Employees.
Effective Date
section 1255(1) of Pub. L. 111–148section 300gg of this titleSection effective , see , set out as a note under .