US Code

Public Law 119-102 (07/12/2026)

42 U.S.C. § 300gg–11

No lifetime or annual limits

Section text and notes

(a)

Prohibition

(1)

In general

A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—
(A)
lifetime limits on the dollar value of benefits for any participant or beneficiary; or
(B)
except as provided in paragraph (2), annual limits on the dollar value of benefits for any participant or beneficiary.
(2)

Annual limits prior to 2014

section 18022(b) of this titleWith respect to plan years beginning prior to , a group health plan and a health insurance issuer offering group or individual health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or beneficiary with respect to the scope of benefits that are essential health benefits under , as determined by the Secretary. In defining the term “restricted annual limit” for purposes of the preceding sentence, the Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.

(b)

Per beneficiary limits

section 18022(b) of this titleSubsection (a) shall not be construed to prevent a group health plan or health insurance coverage from placing annual or lifetime per beneficiary limits on specific covered benefits that are not essential health benefits under , to the extent that such limits are otherwise permitted under Federal or State law.

July 1, 1944, ch. 373 Pub. L. 111–148, title I, § 1001(5)124 Stat. 131 (, title XXVII, § 2711, as added and amended , title X, § 10101(a), , , 883.)

Editorial Notes

Prior Provisions

act July 1, 1944, ch. 373, title XXVII, § 2711 Pub. L. 104–191, title I, § 102(a)110 Stat. 1962 section 300gg–1 of this titlePub. L. 111–148, title I124 Stat. 130 A prior section 300gg–11, , as added , , , which related to guaranteed availability of coverage for employers in a group market, was renumbered section 2731 of act , amended, and transferred to subsecs. (c) and (d) of , by , §§ 1001(3), 1563(c)(8), formerly § 1562(c)(8), title X, § 10107(b)(1), , , 266, 911.

section 238j of this titleAnother prior section 2711 of act , was successively renumbered by subsequent acts and transferred, see .

Amendments

Pub. L. 111–148, § 10101(a)2010—, amended section generally. Prior to amendment, text read as follows:

In General“(a) .—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—

“(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or

section 223 of title 26“(2) unreasonable annual limits (within the meaning of ) on the dollar value of benefits for any participant or beneficiary.

Per Beneficiary Limitssection 18022(b) of this title“(b) .—Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.”

Statutory Notes and Related Subsidiaries

Effective Date

Pub. L. 111–148, title I, § 1004124 Stat. 140

“(a)

In General .—

Pub. L. 111–148section 300gg–13 of this titlesection 300gg–9 of this titleExcept as provided for in subsection (b), this subtitle [subtitle A (§§ 1001–1004) of title I of , enacting this section and sections 300gg–12 to 300gg–15, 300gg–16 to 300gg–19, 300gg–93, and 300gg–94 of this title, amending former sections 300gg–11 and 300gg–12 of this title and sections 300gg–21 to 300gg–23 of this title, and transferring to and sections 300gg–4 to 300gg–7 of this title to sections 300gg–25 to 300gg–28 of this title, respectively] (and the amendments made by this subtitle) shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act [], except that the amendments made by sections 1002 and 1003 [enacting sections 300gg–93 and 300gg–94 of this title] shall become effective for fiscal years beginning with fiscal year 2010.
“(b)

Special Rule .—

The amendments made by sections 1002 and 1003 [enacting sections 300gg–93 and 300gg–94 of this title] shall take effect on the date of enactment of this Act [].”
, , , provided that: