§1191 Preemption; State flexibility; construction

Summary

Says when federal rules replace state rules about group health insurance and preexisting condition limits. Federal rules do not normally cancel state laws that only apply to insurance companies selling group coverage, unless a state rule would stop a federal requirement from being used. It also does not change how section 1144 works for group health plans. For coverage sold by insurers, the federal rules about preexisting condition exclusions (the rules in section 1181) override any state law that conflicts with them. But states may choose stricter or different limits in certain ways: they can shorten the 6-month, 12-month, or 18-month periods; change the 63-day or 30-day references to a longer number of days; ban some preexisting condition exclusions or add more exceptions; require extra special enrollment times; or shorten the maximum allowed affiliation period. The part does not force plans to provide particular benefits except as section 1185 says. "State law" means any state rule, decision, or regulation, and "State" includes the Northern Mariana Islands and local governments. A U.S. law that only applies to the District of Columbia counts as a state law.