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Title 42 — The Public Health and WelfareRelease 119-73

§300gg–11 No lifetime or annual limits

Title 42 › Chapter CHAPTER 6A— - PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER XXV— - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part Part A— - Individual and Group Market Reforms › Subpart Subpart II— - Improving Coverage › § 300gg–11

Last updated Apr 6, 2026|Official source

Summary

Group health plans and health insurance providers must not put a dollar cap that lasts a person’s whole life on benefits. They also must not set yearly dollar caps on benefits, except as explained next. For plan years starting before January 1, 2014, they could have a limited yearly cap only for the services that are "essential health benefits" in section 18022(b). The Secretary must define "restricted annual limit" and make sure needed care stays available without big premium increases. Plans and insurers may still place yearly or lifetime limits on specific benefits that are not essential health benefits if federal or state law allows it.

Full Legal Text

Title 42, §300gg–11

The Public Health and Welfare — Source: USLM XML via OLRC

(a)(1)A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—
(A)lifetime limits on the dollar value of benefits for any participant or beneficiary; or
(B)except as provided in paragraph (2), annual limits on the dollar value of benefits for any participant or beneficiary.
(2)With respect to plan years beginning prior to January 1, 2014, a group health plan and a health insurance issuer offering group or individual health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or beneficiary with respect to the scope of benefits that are essential health benefits under section 18022(b) of this title, as determined by the Secretary. In defining the term “restricted annual limit” for purposes of the preceding sentence, the Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.
(b)Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage from placing annual or lifetime per beneficiary limits on specific covered benefits that are not essential health benefits under section 18022(b) of this title, to the extent that such limits are otherwise permitted under Federal or State law.

Legislative History

Notes & Related Subsidiaries

Editorial Notes

Prior Provisions

A prior section 300gg–11, act
July 1, 1944, ch. 373, title XXVII, § 2711, as added Pub. L. 104–191, title I, § 102(a), Aug. 21, 1996, 110 Stat. 1962, which related to guaranteed availability of coverage for employers in a group market, was renumbered section 2731 of act
July 1, 1944, amended, and transferred to subsecs. (c) and (d) of section 300gg–1 of this title, by Pub. L. 111–148, title I, §§ 1001(3), 1563(c)(8), formerly § 1562(c)(8), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 130, 266, 911. Another prior section 2711 of act
July 1, 1944, was successively renumbered by subsequent acts and transferred, see section 238j of this title.

Amendments

2010—Pub. L. 111–148, § 10101(a), amended section generally. Prior to amendment, text read as follows: “(a) In General.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish— “(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or “(2) unreasonable annual limits (within the meaning of section 223 of title 26) on the dollar value of benefits for any participant or beneficiary. “(b) Per Beneficiary Limits.—Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 18022(b) of this title from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.”

Statutory Notes and Related Subsidiaries

Effective Date

Pub. L. 111–148, title I, § 1004, Mar. 23, 2010, 124 Stat. 140, provided that: “(a) In General.—Except as provided for in subsection (b), this subtitle [subtitle A (§§ 1001–1004) of title I of Pub. L. 111–148, enacting this section and sections 300gg–12 to 300gg–15, 300gg–16 to 300gg–19, 300gg–93, and 300gg–94 of this title, amending former section 300gg–11 and 300gg–12 of this title and sections 300gg–21 to 300gg–23 of this title, and transferring section 300gg–13 of this title to section 300gg–9 of this title and sections 300gg–4 to 300gg–7 of this title to sections 300gg–25 to 300gg–28 of this title, respectively] (and the

Amendments

made by this subtitle) shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act [Mar. 23, 2010], except that the

Amendments

made by section 1002 and 1003 [enacting section 300gg–93 and 300gg–94 of this title] shall become effective for fiscal years beginning with fiscal year 2010. “(b) Special Rule.—The

Amendments

made by section 1002 and 1003 [enacting section 300gg–93 and 300gg–94 of this title] shall take effect on the date of enactment of this Act [Mar. 23, 2010].”

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–11

Title 42 — The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73