§1191b Definitions

Summary

Gives plain meanings for key words used in this part so people know what the rules cover. Group health plan — a workplace benefit plan that pays for medical care for employees or their dependents, but it does not include a qualified small employer health reimbursement arrangement (section 9831(d)(2) of title 26). Medical care — money paid for diagnosing, treating, preventing, or affecting the body, for transportation that is essential to that care, and for insurance that pays for those things. Health insurance coverage — medical benefits provided under a hospital, medical service, or HMO contract offered by a health insurer. Health insurance issuer — an insurance company, service, or organization (including an HMO) licensed and regulated by a State; it does not mean a group health plan. Health maintenance organization — a federally qualified HMO, a State-recognized HMO, or a similar State-regulated organization. Group health insurance coverage — the insurance offered with a group health plan. Excepted benefits — certain limited kinds of coverage, such as accident or disability plans, liability supplements and workers’ compensation, on-site clinic care, limited dental or vision, long-term care or nursing-home services, specific-disease or fixed indemnity plans, and Medicare/DoD/other similar supplemental coverage. COBRA continuation provision — Part 6 of this subtitle; section 4980B of title 26 (except subsection (f)(1) as it relates to pediatric vaccines); and Title XXII of the Public Health Service Act. Health status-related factor — the health-related factors listed in section 1182(a)(1). Network plan — coverage that uses a defined group of contracted providers. Placement for adoption — has the meaning in section 1169(c)(3)(B). Family member — a dependent and any first- through fourth-degree relative. Genetic information — facts about a person’s or family members’ genetic tests, family disease signs, and requests for or use of genetic services or related research; it does not include sex or age. Genetic test — an analysis of DNA, RNA, chromosomes, proteins, or metabolites that finds genotypes, mutations, or chromosomal changes, but not protein/metabolite tests that do not detect those changes or that only relate to an already obvious disease. Genetic services — genetic tests, counseling, or education. Underwriting purposes — actions about eligibility or enrollment, premium or contribution calculations, pre-existing condition rules, and other steps used to create, renew, or replace health insurance or benefits.