U.S Code last checked for updates: Jul 24, 2024
§ 9832.
Definitions
(a)
Group health plan
(b)
Definitions relating to health insurance
For purposes of this chapter—
(1)
Health insurance coverage
(A)
In general
(B)
No application to certain excepted benefits
(2)
Health insurance issuer
(3)
Health maintenance organization
The term “health maintenance organization” means—
(A)
a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act (42 U.S.C. 300e(a))),
(B)
an organization recognized under State law as a health maintenance organization, or
(C)
a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization.
(c)
Excepted benefits
For purposes of this chapter, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:
(1)
Benefits not subject to requirements
(A)
Coverage only for accident, or disability income insurance, or any combination thereof.
(B)
Coverage issued as a supplement to liability insurance.
(C)
Liability insurance, including general liability insurance and automobile liability insurance.
(D)
Workers’ compensation or similar insurance.
(E)
Automobile medical payment insurance.
(F)
Credit-only insurance.
(G)
Coverage for on-site medical clinics.
(H)
Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
(2)
Benefits not subject to requirements if offered separately
(A)
Limited scope dental or vision benefits.
(B)
Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
(C)
Such other similar, limited benefits as are specified in regulations.
(3)
Benefits not subject to requirements if offered as independent, noncoordinated benefits
(A)
Coverage only for a specified disease or illness.
(B)
Hospital indemnity or other fixed indemnity insurance.
(4)
Benefits not subject to requirements if offered as separate insurance policy
(d)
Other definitions
For purposes of this chapter—
(1)
COBRA continuation provision
The term “COBRA continuation provision” means any of the following:
(A)
Section 4980B, other than subsection (f)(1) thereof insofar as it relates to pediatric vaccines.
(B)
Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.), other than section 609 of such Act.
(C)
Title XXII of the Public Health Service Act.
(2)
Governmental plan
(3)
Medical care
The term “medical care” has the meaning given such term by section 213(d) determined without regard to—
(A)
paragraph (1)(C) thereof, and
(B)
so much of paragraph (1)(D) thereof as relates to qualified long-term care insurance.
(4)
Network plan
(5)
Placed for adoption defined
(6)
Family member
The term “family member” means, with respect to any individual—
(A)
a dependent (as such term is used for purposes of section 9801(f)(2)) of such individual, and
(B)
any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual or of an individual described in subparagraph (A).
(7)
Genetic information
(A)
In general
The term “genetic information” means, with respect to any individual, information about—
(i)
such individual’s genetic tests,
(ii)
the genetic tests of family members of such individual, and
(iii)
the manifestation of a disease or disorder in family members of such individual.
(B)
Inclusion of genetic services and participation in genetic research
(C)
Exclusions
(8)
Genetic test
(A)
In general
(B)
Exceptions
The term “genetic test” does not mean—
(i)
an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or
(ii)
an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.
(9)
Genetic services
The term “genetic services” means—
(A)
a genetic test;
(B)
genetic counseling (including obtaining, interpreting, or assessing genetic information); or
(C)
genetic education.
(10)
Underwriting purposes
The term “underwriting purposes” means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan—
(A)
rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage;
(B)
the computation of premium or contribution amounts under the plan or coverage;
(C)
the application of any pre-existing condition exclusion under the plan or coverage; and
(D)
other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
(Added Pub. L. 104–191, title IV, § 401(a), Aug. 21, 1996, 110 Stat. 2080, § 9805; renumbered § 9832, Pub. L. 105–34, title XV, § 1531(a)(2), Aug. 5, 1997, 111 Stat. 1081; amended Pub. L. 110–233, title I, § 103(d), May 21, 2008, 122 Stat. 898.)
cite as: 26 USC 9832