§1191a Special rules relating to group health plans

Summary

Some group health plans do not have to follow these rules. If a plan has fewer than 2 participants who are current employees on the first day of the plan year, the rules do not apply except for sections 1185 and 1185o, which still do. Plans that only provide "excepted benefits" listed in 1191b(c)(1) are also exempt. For other types of excepted benefits (the ones in 1191b(c)(2)–(4)), the plan is exempt only when the benefits are offered under a separate policy or are not an integral part of the main plan. For the kind covered by 1191b(c)(3), there are extra limits: the benefits must be under a separate contract, must not be coordinated with any exclusion in another plan by the same sponsor, and must be paid regardless of whether another plan pays for the same event. A partnership program that gives medical care to current or former partners (or their dependents) — even if it wouldn’t normally count as an employee plan — will be treated as a group health plan for these rules. In that case, the partnership counts as the employer for partners, and "participants" include partners and self-employed individuals in plans that cover employees.