Internal Revenue Code:Sec. 9802. Prohibiting discrimination against individual participants and beneficiaries based on health status

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Location in Internal Revenue Code

     TITLE 26 - INTERNAL REVENUE CODE
      Subtitle K - Group Health Plan Requirements
       CHAPTER 100 - GROUP HEALTH PLAN REQUIREMENTS
        Subchapter A - Requirements Relating to Portability, Access, and
              Renewability
       

Statute

    Sec. 9802. Prohibiting discrimination against individual
        participants and beneficiaries based on health status
 
    (a) In eligibility to enroll
      (1) In general
        Subject to paragraph (2), a group health plan may not establish
      rules for eligibility (including continued eligibility) of any
      individual to enroll under the terms of the plan based on any of
      the following factors in relation to the individual or a
      dependent of the individual:
          (A) Health status.
          (B) Medical condition (including both physical and mental
        illnesses).
          (C) Claims experience.
          (D) Receipt of health care.
          (E) Medical history.
          (F) Genetic information.
          (G) Evidence of insurability (including conditions arising
        out of acts of domestic violence).
          (H) Disability.
      (2) No application to benefits or exclusions
        To the extent consistent with section 9801, paragraph (1) shall
      not be construed -
          (A) to require a group health plan to provide particular
        benefits (or benefits with respect to a specific procedure,
        treatment, or service) other than those provided under the
        terms of such plan; or
          (B) to prevent such a plan from establishing limitations or
        restrictions on the amount, level, extent, or nature of the
        benefits or coverage for similarly situated individuals
        enrolled in the plan or coverage.
      (3) Construction
        For purposes of paragraph (1), rules for eligibility to enroll
      under a plan include rules defining any applicable waiting
      periods for such enrollment.
    (b) In premium contributions
      (1) In general
        A group health plan may not require any individual (as a
      condition of enrollment or continued enrollment under the plan)
      to pay a premium or contribution which is greater than such
      premium or contribution for a similarly situated individual
      enrolled in the plan on the basis of any factor described in
      subsection (a)(1) in relation to the individual or to an
      individual enrolled under the plan as a dependent of the
      individual.
      (2) Construction
        Nothing in paragraph (1) shall be construed -
          (A) to restrict the amount that an employer may be charged
        for coverage under a group health plan; or
          (B) to prevent a group health plan from establishing premium
        discounts or rebates or modifying otherwise applicable
        copayments or deductibles in return for adherence to programs
        of health promotion and disease prevention.
    (c) Special rules for church plans
      A church plan (as defined in section 414(e)) shall not be treated
    as failing to meet the requirements of this section solely because
    such plan requires evidence of good health for coverage of -
        (1) both any employee of an employer with 10 or less employees
      (determined without regard to section 414(e)(3)(C)) and any
      self-employed individual, or
        (2) any individual who enrolls after the first 90 days of
      initial eligibility under the plan.
    This subsection shall apply to a plan for any year only if the plan
    included the provisions described in the preceding sentence on July
    15, 1997, and at all times thereafter before the beginning of such
    year.
 

Sources

    (Added Pub. L. 104-191, title IV, Sec. 401(a), Aug. 21, 1996, 110
    Stat. 2078; amended Pub. L. 105-34, title XV, Sec. 1532(a), Aug. 5,
    1997, 111 Stat. 1085.)
 

Miscellaneous

                                 AMENDMENTS
      1997 - Subsec. (c). Pub. L. 105-34 added subsec. (c).
                      EFFECTIVE DATE OF 1997 AMENDMENT
      Section 1532(b) of Pub. L. 105-34 provided that: ''The amendments
    made by subsection (a) (amending this section) shall take effect as
    if included in the amendments made by section 401(a) of the Health
    Insurance Portability and Accountability Act of 1996 (Pub. L.
    104-191).''
 

References

                   SECTION REFERRED TO IN OTHER SECTIONS
      This section is referred to in section 9803 of this title.