US Code

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

42 U.S.C. § 300gg–22

Enforcement

Section text and notes

(a)

State enforcement

(1)

State authority

1

1 See References in Text note below.
section 300gg–121 of this titleSubject to section 300gg–23  of this title, each State may require that health insurance issuers that issue, sell, renew, or offer health insurance coverage in the State in the individual or group market meet the requirements of this part and part D (other than ) with respect to such issuers.

(2)

Failure to implement provisions

section 300gg–121 of this titleIn the case of a determination by the Secretary that a State has failed to substantially enforce a provision (or provisions) in this part or part D (other than ) with respect to health insurance issuers in the State, the Secretary shall enforce such provision (or provisions) under subsection (b) insofar as they relate to the issuance, sale, renewal, and offering of health insurance coverage in connection with group health plans or individual health insurance coverage in such State.

(b)

Secretarial enforcement authority

(1)

Limitation

section 300gg–121 of this titleThe provisions of this subsection shall apply to enforcement of a provision (or provisions) of this part or part D (other than ) only—
(A)
as provided under subsection (a)(2); and
(B)
with respect to individual health insurance coverage or group health plans that are non-Federal governmental plans.
(2)

Imposition of penalties

In the cases described in paragraph (1)—
(A)

In general

section 300gg–121 of this titleSubject to the succeeding provisions of this subsection, any non-Federal governmental plan that is a group health plan and any health insurance issuer that fails to meet a provision of this part or part D (other than ) applicable to such plan or issuer is subject to a civil money penalty under this subsection.

(B)

Liability for penalty

In the case of a failure by—
(i)
a health insurance issuer, the issuer is liable for such penalty, or
(ii)
a group health plan that is a non-Federal governmental plan which is—
(I)
sponsored by 2 or more employers, the plan is liable for such penalty, or
(II)
not so sponsored, the employer is liable for such penalty.
(C)

Amount of penalty

(i)

In general

The maximum amount of penalty imposed under this paragraph is $100 for each day for each individual with respect to which such a failure occurs.

(ii)

Considerations in imposition

section 300gg–121 of this titleIn determining the amount of any penalty to be assessed under this paragraph, the Secretary shall take into account the previous record of compliance of the entity being assessed with the applicable provisions of this part and part D (other than ) and the gravity of the violation.

(iii)

Limitations

(I)

Penalty not to apply where failure not discovered exercising reasonable diligence

No civil money penalty shall be imposed under this paragraph on any failure during any period for which it is established to the satisfaction of the Secretary that none of the entities against whom the penalty would be imposed knew, or exercising reasonable diligence would have known, that such failure existed.

(II)

Penalty not to apply to failures corrected within 30 days

No civil money penalty shall be imposed under this paragraph on any failure if such failure was due to reasonable cause and not to willful neglect, and such failure is corrected during the 30-day period beginning on the first day any of the entities against whom the penalty would be imposed knew, or exercising reasonable diligence would have known, that such failure existed.

(D)

Administrative review

(i)

Opportunity for hearing

section 554 of title 5The entity assessed shall be afforded an opportunity for hearing by the Secretary upon request made within 30 days after the date of the issuance of a notice of assessment. In such hearing the decision shall be made on the record pursuant to . If no hearing is requested, the assessment shall constitute a final and unappealable order.

(ii)

Hearing procedure

If a hearing is requested, the initial agency decision shall be made by an administrative law judge, and such decision shall become the final order unless the Secretary modifies or vacates the decision. Notice of intent to modify or vacate the decision of the administrative law judge shall be issued to the parties within 30 days after the date of the decision of the judge. A final order which takes effect under this paragraph shall be subject to review only as provided under subparagraph (E).

(E)

Judicial review

(i)

Filing of action for review

Any entity against whom an order imposing a civil money penalty has been entered after an agency hearing under this paragraph may obtain review by the United States district court for any district in which such entity is located or the United States District Court for the District of Columbia by filing a notice of appeal in such court within 30 days from the date of such order, and simultaneously sending a copy of such notice by registered mail to the Secretary.

(ii)

Certification of administrative record

The Secretary shall promptly certify and file in such court the record upon which the penalty was imposed.

(iii)

Standard for review

section 706(2)(E) of title 5The findings of the Secretary shall be set aside only if found to be unsupported by substantial evidence as provided by .

(iv)

Appeal

Any final decision, order, or judgment of the district court concerning such review shall be subject to appeal as provided in chapter 83 of title 28.

(F)

Failure to pay assessment; maintenance of action

(i)

Failure to pay assessment

If any entity fails to pay an assessment after it has become a final and unappealable order, or after the court has entered final judgment in favor of the Secretary, the Secretary shall refer the matter to the Attorney General who shall recover the amount assessed by action in the appropriate United States district court.

(ii)

Nonreviewability

In such action the validity and appropriateness of the final order imposing the penalty shall not be subject to review.

(G)

Payment of penalties

Except as otherwise provided, penalties collected under this paragraph shall be paid to the Secretary (or other officer) imposing the penalty and shall be available without appropriation and until expended for the purpose of enforcing the provisions with respect to which the penalty was imposed.

(3)

Enforcement authority relating to genetic discrimination

(A)

General rule

111In the cases described in paragraph (1), notwithstanding the provisions of paragraph (2)(C), the succeeding subparagraphs of this paragraph shall apply with respect to an action under this subsection by the Secretary with respect to any failure of a health insurance issuer in connection with a group health plan, to meet the requirements of subsection (a)(1)(F), (b)(3), (c), or (d) of section 2702  or section 2701  or 2702(b)(1)  with respect to genetic information in connection with the plan.

(B)

Amount

(i)

In general

The amount of the penalty imposed under this paragraph shall be $100 for each day in the noncompliance period with respect to each participant or beneficiary to whom such failure relates.

(ii)

Noncompliance period

For purposes of this paragraph, the term “noncompliance period” means, with respect to any failure, the period—
(I)
beginning on the date such failure first occurs; and
(II)
ending on the date the failure is corrected.
(C)

Minimum penalties where failure discovered

Notwithstanding clauses (i) and (ii) of subparagraph (D):
(i)

In general

In the case of 1 or more failures with respect to an individual—
(I)
which are not corrected before the date on which the plan receives a notice from the Secretary of such violation; and
(II)
which occurred or continued during the period involved;
 the amount of penalty imposed by subparagraph (A) by reason of such failures with respect to such individual shall not be less than $2,500.
(ii)

Higher minimum penalty where violations are more than de minimis

To the extent violations for which any person is liable under this paragraph for any year are more than de minimis, clause (i) shall be applied by substituting “$15,000” for “$2,500” with respect to such person.

(D)

Limitations

(i)

Penalty not to apply where failure not discovered exercising reasonable diligence

No penalty shall be imposed by subparagraph (A) on any failure during any period for which it is established to the satisfaction of the Secretary that the person otherwise liable for such penalty did not know, and exercising reasonable diligence would not have known, that such failure existed.

(ii)

Penalty not to apply to failures corrected within certain periods

No penalty shall be imposed by subparagraph (A) on any failure if—
(I)
such failure was due to reasonable cause and not to willful neglect; and
(II)
such failure is corrected during the 30-day period beginning on the first date the person otherwise liable for such penalty knew, or exercising reasonable diligence would have known, that such failure existed.
(iii)

Overall limitation for unintentional failures

In the case of failures which are due to reasonable cause and not to willful neglect, the penalty imposed by subparagraph (A) for failures shall not exceed the amount equal to the lesser of—
(I)
10 percent of the aggregate amount paid or incurred by the employer (or predecessor employer) during the preceding taxable year for group health plans; or
(II)
$500,000.
(E)

Waiver by Secretary

In the case of a failure which is due to reasonable cause and not to willful neglect, the Secretary may waive part or all of the penalty imposed by subparagraph (A) to the extent that the payment of such penalty would be excessive relative to the failure involved.

July 1, 1944, ch. 373 Pub. L. 104–191, title I, § 102(a)110 Stat. 1968 Pub. L. 110–233, title I, § 102(a)(5)122 Stat. 891 Pub. L. 111–148, title I124 Stat. 130 Pub. L. 116–260, div. BB, title I, § 102(a)(3)(C)134 Stat. 2772 Pub. L. 119–75, div. J, title VII, § 6701(a)(2)140 Stat. 713 (, title XXVII, § 2723, formerly § 2722, as added , , ; amended , , ; renumbered § 2736, renumbered § 2723, and amended , §§ 1001(4), 1563(c)(13), formerly § 1562(c)(13), title X, § 10107(b)(1), , , 269, 911; , , ; , , .)

Editorial Notes

References in Text

Section 300gg–23 of this titlePub. L. 111–148, title I124 Stat. 130 , referred to in subsec. (a)(1), was in the original section “2723”, and was translated as meaning section 2724 of act , to reflect the probable intent of Congress and the renumbering of section 2723 as 2724 by , §§ 1001(4), 1563(c)(14)(B), formerly § 1562(c)(14)(B), title X, § 10107(b)(1), , , 269, 911.

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. (b)(3)(A), 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, related to guaranteed availability of coverage, was added by , , , effective for plan years beginning on or after , and is classified to .

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. (b)(3)(A), 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 .

Prior Provisions

section 300gg–23 of this titleA prior section 2723 of act , was renumbered section 2724 and is classified to .

Amendments

Pub. L. 119–75section 300gg–121 of this title2026— inserted “(other than ” after “part D” wherever appearing.

Pub. L. 116–260, § 102(a)(3)(C)(i)2020—Subsec. (a)(1). , inserted “and part D” after “this part”.

Pub. L. 116–260, § 102(a)(3)(C)(ii)Subsecs. (a)(2), (b)(1), (2)(A). –(iv), inserted “or part D” after “this part”.

Pub. L. 116–260, § 102(a)(3)(C)(v)Subsec. (b)(2)(C)(ii). , inserted “and part D” after “this part”.

Pub. L. 111–148, § 1563(c)(13)(A)(i)Pub. L. 111–148, § 10107(b)(1)2010—Subsec. (a)(1). , formerly § 1562(c)(13)(A)(i), as renumbered by , substituted “individual or group market” for “small or large group markets”.

Pub. L. 111–148, § 1563(c)(13)(a)(ii)Pub. L. 111–148, § 10107(b)(1)Subsec. (a)(2). , formerly § 1562(c)(13)(A)(ii), as renumbered by , inserted “or individual health insurance coverage” after “group health plans”.

Pub. L. 111–148, § 1563(c)(13)(B)Pub. L. 111–148, § 10107(b)(1)Subsec. (b)(1)(B). , formerly § 1562(c)(13)(B), as renumbered by , inserted “individual health insurance coverage or” after “with respect to”.

Pub. L. 110–2332008—Subsec. (b)(3). added par. (3).

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. 110–233section 102(d)(2) of Pub. L. 110–233section 300gg–21 of this titleAmendment by applicable, 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 one year after , and, with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market, after the date that is one year after , see , set out as a 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 .