US Code

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

42 U.S.C. § 300gg–21

Exclusion of certain plans

Section text and notes

(a)

Limitation on application of provisions relating to group health plans

(1)

In general

1
1 See References in Text note below.
The requirements of subparts 1 and 2  and part D shall apply with respect to group health plans only—
(A)
subject to paragraph (2), in the case of a plan that is a nonfederal governmental plan, and
(B)
with respect to health insurance coverage offered in connection with a group health plan (including such a plan that is a church plan or a governmental plan).
(2)

Treatment of non-Federal governmental plans

(A)

Election to be excluded

1Except as provided in subparagraph (D) or (E), if the plan sponsor of a nonfederal governmental plan which is a group health plan to which the provisions of subparts 1 and 2  otherwise apply makes an election under this subparagraph (in such form and manner as the Secretary may by regulations prescribe), then the requirements of such subparts insofar as they apply directly to group health plans (and not merely to group health insurance coverage) shall not apply to such governmental plans for such period except as provided in this paragraph.

(B)

Period of election

An election under subparagraph (A) shall apply—
(i)
for a single specified plan year, or
(ii)
in the case of a plan provided pursuant to a collective bargaining agreement, for the term of such agreement.
An election under clause (i) may be extended through subsequent elections under this paragraph.
(C)

Notice to enrollees

Under such an election, the plan shall provide for—
(i)
notice to enrollees (on an annual basis and at the time of enrollment under the plan) of the fact and consequences of such election, and
(ii)
1 certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with section 2701(e).
(D)

Election not applicable to requirements concerning genetic information

111The election described in subparagraph (A) shall not be available with respect to the provisions of subsections (a)(1)(F), (b)(3), (c), and (d) of section 2702  and the provisions of sections 2701  and 2702(b)  to the extent that such provisions apply to genetic information.

(E)

Election not applicable

The election described in subparagraph (A) shall not be available with respect to the provisions of subparts I and II.

(F)

Sunset of election option

(i)

In general

Notwithstanding the preceding provisions of this paragraph—
(I)
section 300gg–26 of this title no election described in subparagraph (A) with respect to may be made on or after ; and
(II)
section 300gg–26 of this title except as provided in clause (ii), no such election with respect to expiring on or after the date that is 180 days after , may be renewed.
(ii)

Exception for certain collectively bargained plans

section 300gg–26 of this titleNotwithstanding clause (i)(II), a plan described in subparagraph (B)(ii) that is subject to multiple agreements described in such subparagraph of varying lengths and that has an election described in subparagraph (A) with respect to in effect as of , that expires on or after the date that is 180 days after , may extend such election until the date on which the term of the last such agreement expires.

(b)

Exception for certain benefits

1section 300gg–91(c)(1) of this titleThe requirements of subparts 1 and 2  and part D shall not apply to any individual coverage or any group health plan (or group health insurance coverage) in relation to its provision of excepted benefits described in .

(c)

Exception for certain benefits if certain conditions met

(1)

Limited, excepted benefits

1section 300gg–91(c)(2) of this titleThe requirements of subparts 1 and 2  and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in if the benefits—
(A)
are provided under a separate policy, certificate, or contract of insurance; or
(B)
are otherwise not an integral part of the plan.
(2)

Noncoordinated, excepted benefits

1section 300gg–91(c)(3) of this titleThe requirements of subparts 1 and 2  and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage offered in connection with a group health plan) in relation to its provision of excepted benefits described in if all of the following conditions are met:
(A)
The benefits are provided under a separate policy, certificate, or contract of insurance.
(B)
There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor.
(C)
Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer.
(3)

Supplemental excepted benefits

1The requirements of this part and part D shall not apply to any individual coverage or any group health plan (and group health insurance coverage) in relation to its provision of excepted benefits described in section 300gg–91(c)(4)  of this title if the benefits are provided under a separate policy, certificate, or contract of insurance.

(d)

Treatment of partnerships

For purposes of this part and part D—
(1)

Treatment as a group health plan

Any plan, fund, or program which would not be (but for this subsection) an employee welfare benefit plan and which is established or maintained by a partnership, to the extent that such plan, fund, or program provides medical care (including items and services paid for as medical care) to present or former partners in the partnership or to their dependents (as defined under the terms of the plan, fund, or program), directly or through insurance, reimbursement, or otherwise, shall be treated (subject to paragraph (2)) as an employee welfare benefit plan which is a group health plan.

(2)

Employer

In the case of a group health plan, the term “employer” also includes the partnership in relation to any partner.

(3)

Participants of group health plans

In the case of a group health plan, the term “participant” also includes—
(A)
in connection with a group health plan maintained by a partnership, an individual who is a partner in relation to the partnership, or
(B)
in connection with a group health plan maintained by a self-employed individual (under which one or more employees are participants), the self-employed individual,
if such individual is, or may become, eligible to receive a benefit under the plan or such individual’s beneficiaries may be eligible to receive any such benefit.

July 1, 1944, ch. 373 Pub. L. 104–191, title I, § 102(a)110 Stat. 1967 Pub. L. 104–204, title VI, § 604(b)(1)110 Stat. 2940 Pub. L. 110–233, title I, § 102(c)122 Stat. 895 Pub. L. 111–148, title I124 Stat. 130 Pub. L. 116–260, div. BB, title I, § 102(a)(3)(B)134 Stat. 2772 Pub. L. 117–328, div. FF, title I, § 1321136 Stat. 5697 (, title XXVII, § 2722, formerly § 2721, as added , , ; amended , , ; , , ; renumbered § 2735, renumbered § 2722, and amended , §§ 1001(4), 1563(a), (c)(12), formerly § 1562(a), (c)(12), title X, § 10107(a), (b)(1), , , 264, 268, 911; , , ; , , .)

Editorial Notes

References in Text

Pub. L. 111–148, title I124 Stat. 130 portability, access, and renewability requirementsgeneral reformsection 300gg of this titleimproving coveragesection 300gg–11 of this titleother requirementssection 300gg–4 of this titleexclusion of plans; enforcement; preemptionsection 300gg–21 of this titleSubparts 1 and 2, referred to in subsecs. (a)(1), (2)(A), (b), and (c)(1), (2), were amended by , §§ 1001(5), 1201(1), 1563(c)(2), (11), formerly § 1562(c)(2), (11), title X, § 10107(b)(1), , , 154, 265, 268, 911. The subpart 1 designation and heading “” were struck out and a new subpart I designation and heading “” were enacted preceding , effective for plan years beginning on or after . A new subpart II designation and heading “” were enacted preceding . The subpart 2 designation and heading “” were struck out preceding , and subpart 4 was redesignated as subpart 2 “” preceding .

section 300gg of this titlePub. L. 111–148, title I124 Stat. 154 section 300gg–3 of this titlePub. L. 111–148, title I, § 1201(4)124 Stat. 155 section 300gg of this titleSection 2701, referred to in subsec. (a)(2)(C)(ii), (D), is a reference to section 2701 of act . Section 2701, which was classified to , was renumbered section 2704, effective for plan years beginning on or after , with certain exceptions, and amended, by , §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), , , 264, 911, and was transferred to . A new section 2701 of act , related to fair health insurance premiums, was added, effective for plan years beginning on or after , and amended, by , title X, § 10103(a), , , 892, and is classified to .

section 300gg–1 of this titlePub. L. 111–148, title I, § 1201(3)124 Stat. 154 section 300gg–4 of this titlePub. L. 111–148, title I, § 1201(4)124 Stat. 156 section 300gg–1 of this titleSection 2702, referred to in subsec. (a)(2)(D), is a reference to section 2702 of act . Section 2702, which was classified to , was amended by , , , and was transferred to subsecs. (b) to (f) of , effective for plan years beginning on or after . A new section 2702 of act , related to guaranteed availability of coverage, was added by , , , effective for plan years beginning on or after , and is classified to .

Section 300gg–91(c)(4) of this titlePub. L. 104–191, § 102(a), referred to in subsec. (c)(3), was in the original “section 27971(c)(4)” and was translated as reading “section 2791(c)(4)”, meaning section 2791(c)(4) of act , as added by , to reflect the probable intent of Congress. Act , does not contain a section 27971.

Prior Provisions

section 300gg–22 of this titleA prior section 2722 of act , was renumbered section 2723 and is classified to .

Amendments

Pub. L. 117–3282022—Subsec. (a)(2)(F). added subpar. (F).

Pub. L. 116–260, § 102(a)(3)(B)(i)2020—Subsecs. (a)(1), (b), (c)(1), (2). –(iv), inserted “and part D” after “subparts 1 and 2” in introductory provisions of subsecs. (a)(1) and (c)(1), (2) and in subsec. (b).

Pub. L. 116–260, § 102(a)(3)(B)(v)Subsecs. (c)(3), (d). , (vi), inserted “and part D” after “this part”.

Pub. L. 111–148, § 1563(c)(12)(B)Pub. L. 111–148, § 10107(b)(1)Pub. L. 111–1482010—, formerly § 1562(c)(12)(B), as renumbered by , which directed amendment of section by substituting “subpart 1” for “subparts 1 through 3” wherever appearing, could not be executed because the words “subparts 1 through 3” did not appear subsequent to amendments by section 1563(a)(2)(A), (B)(ii), (3), (4)(A), (B)(i) of . See below.

Pub. L. 111–148, § 1563(c)(12)(C)Pub. L. 111–148, § 10107(b)(1)Subsec. (a). , formerly § 1562(c)(12)(C), as renumbered by , redesignated subsec. (b) as (a).

Pub. L. 111–148Pub. L. 111–148, § 10107(b)(1), §§ 1563(a)(1) and 1563(c)(12)(A), formerly §§ 1562(a)(1) and 1562(c)(12)(A), as renumbered by , made identical amendment, striking out subsec. (a). Prior to amendment, text read as follows: “The requirements of subparts 1 and 3 shall not apply to any group health plan (and health insurance coverage offered in connection with a group health plan) for any plan year if, on the first day of such plan year, such plan has less than 2 participants who are current employees.”

Pub. L. 111–148, § 1563(c)(12)(C)Pub. L. 111–148, § 10107(b)(1)Subsec. (b). , formerly § 1562(c)(12)(C), as renumbered by , redesignated subsec. (c) as (b). Former subsec. (b) redesignated (a).

Pub. L. 111–148, § 1563(a)(2)(A)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(2)(A), as renumbered by , substituted “subparts 1 and 2” for “subparts 1 through 3” in introductory provisions.

Pub. L. 111–148, § 1563(a)(2)(B)(ii)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(2)(B)(ii), as renumbered by , substituted “subparts 1 and 2” for “subparts 1 through 3”.

Pub. L. 111–148, § 1563(a)(2)(B)(i)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(2)(B)(i), as renumbered by , substituted “subparagraph (D) or (E)” for “subparagraph (D)”.

Pub. L. 111–148, § 10107(a)Subsec. (b)(2)(E). , substituted “subparts I and II” for “subpart 1”.

Pub. L. 111–148, § 1563(a)(2)(B)(iii)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(2)(B)(iii), as renumbered by , added subpar. (E).

Pub. L. 111–148, § 1563(c)(12)(C)Pub. L. 111–148, § 10107(b)(1)Subsec. (c). , formerly § 1562(c)(12)(C), as renumbered by , redesignated subsec. (d) as (c). Former subsec. (c) redesignated (b).

Pub. L. 111–148, § 1563(a)(3)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(3), as renumbered by , substituted “subparts 1 and 2 shall not apply to any individual coverage or any group” for “subparts 1 through 3 shall not apply to any group”.

Pub. L. 111–148, § 1563(c)(12)(C)Pub. L. 111–148, § 10107(b)(1)Subsec. (d). , formerly § 1562(c)(12)(C), as renumbered by , redesignated subsec. (e) as (d). Former subsec. (d) redesignated (c).

Pub. L. 111–148, § 1563(a)(4)(A)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(4)(A), as renumbered by , substituted “subparts 1 and 2 shall not apply to any individual coverage or any group” for “subparts 1 through 3 shall not apply to any group” in introductory provisions.

Pub. L. 111–148, § 1563(a)(4)(B)(i)Pub. L. 111–148, § 10107(b)(1), formerly § 1562(a)(4)(B)(i), as renumbered by , substituted “subparts 1 and 2 shall not apply to any individual coverage or any group” for “subparts 1 through 3 shall not apply to any group” in introductory provisions.

Pub. L. 111–148, § 1563(a)(4)(B)(ii)Pub. L. 111–148, § 10107(b)(1)Subsec. (d)(2)(C). , formerly § 1562(a)(4)(B)(ii), as renumbered by , which directed amendment of subpar. (C) by inserting “or, with respect to individual coverage, under any health insurance coverage maintained by the same health insurance issuer” without language specifying placement, was executed by making the insertion before period at end to reflect the probable intent of Congress.

Pub. L. 111–148, § 1563(a)(4)(C)Pub. L. 111–148, § 10107(b)(1)Subsec. (d)(3). , formerly § 1562(a)(4)(C), as renumbered by , substituted “any individual coverage or any group” for “any group”.

Pub. L. 111–148, § 1563(c)(12)(C)Pub. L. 111–148, § 10107(b)(1)Subsec. (e). , formerly § 1562(c)(12)(C), as renumbered by , redesignated subsec. (e) as (d).

Pub. L. 110–233, § 102(c)(1)2008—Subsec. (b)(2)(A). , substituted “Except as provided in subparagraph (D), if the plan sponsor” for “If the plan sponsor”.

Pub. L. 110–233, § 102(c)(2)Subsec. (b)(2)(D). , added subpar. (D).

Pub. L. 104–204, § 604(b)(1)(A)1996—Subsec. (a). , substituted “subparts 1 and 3” for “subparts 1 and 2”.

Pub. L. 104–204, § 604(b)(1)(B)Subsecs. (b) to (d). , substituted “subparts 1 through 3” for “subparts 1 and 2” wherever appearing.

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 of 2008 Amendment

Pub. L. 110–233, title I, § 102(d)(2)122 Stat. 895

section 300gg–53 of this title“The amendments made by this section [enacting and amending this section and sections 300gg–1, 300gg–22, 300gg–61, and 300gg–91 of this title] shall apply—
“(A)
with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after the date that is 1 year after the date of enactment of this Act []; and
“(B)
with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after the date that is 1 year after the date of enactment of this Act.”
, , , provided that:

Effective Date of 1996 Amendment

Pub. L. 104–204section 604(c) of Pub. L. 104–204section 300gg–25 of this titleAmendment by applicable with respect to group health plans for plan years beginning on or after , see set out as an Effective Date note under .

Effective Date

section 102(c) of Pub. L. 104–191section 300gg of this titleSection applicable with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after , except as otherwise provided, see , set out as a note under .

Regulations

Pub. L. 110–233, title I, § 102(d)(1)122 Stat. 895

“Not later than 12 months after the date of enactment of this Act [], the Secretary of Health and Human Services shall issue final regulations to carry out the amendments made by this section [see Effective Date of 2008 Amendment note above].”
, , , provided that:

Assuring Coordination

Pub. L. 110–233, title I, § 106122 Stat. 905

42 U.S.C. 1320d–9“Except as provided in section 105(b)(1) [ note], the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury shall ensure, through the execution of an interagency memorandum of understanding among such Secretaries, that—
“(1)
section 9834 of Title 26section 9802 of Title 26section 1132 of Title 29 regulations, rulings, and interpretations issued by such Secretaries relating to the same matter over which two or more such Secretaries have responsibility under this title [enacting sections 300gg–53 and 1320d–9 of this title and , Internal Revenue Code, amending this section, sections 300gg–1, 300gg–22, 300gg–61, 300gg–91, and 1395ss of this title, sections 9802 and 9832 of Title 26, and sections 1132, 1182, and 1191b of Title 29, Labor, and enacting provisions set out as notes under this section, sections 1320d–9 and 1395ss of this title, , and ] (and the amendments made by this title) are administered so as to have the same effect at all times; and
“(2)
coordination of policies relating to enforcing the same requirements through such Secretaries in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement.”
, , , provided that: