§9831 General exceptions

Summary

Says when the chapter’s rules do not apply to some health plans. Governmental plans are exempt. A group health plan is also exempt for a year if it has fewer than 2 participants who are current employees on the first day of that year. The rules also do not apply to certain "excepted benefits" described in 9832(c)(1) through 9832(c)(4) when those benefits are kept separate or are not a core part of the main plan, and in some cases when there is no coordination with other plans and payouts are made without regard to other plan coverage. Also says a "qualified small employer health reimbursement arrangement" is not treated as a group health plan for this title. In short, that arrangement must be employer-funded only, offer no salary-reduction contributions, pay or reimburse medical care after the employee shows proof of other coverage, be offered on the same terms to all eligible employees, and must not pay more than $4,950 per year (or $10,000 if family members are covered). The dollar limits are increased for years after 2016 for inflation using the cost-of-living formula in section 1(f)(3) with “calendar year 2015” substituted for “calendar year 2016.” An eligible employee is a worker who can take part (with limited exclusions). An eligible employer is one that is not a large employer and does not offer any group health plan. Employers must give each eligible employee a written notice at least 90 days before the plan year (or when the employee first becomes eligible) stating the employee’s maximum benefit, telling the employee to share that amount with a health insurance exchange when applying for premium help, and warning about possible taxes or loss of tax-free status if the employee lacks minimum essential coverage.