Title 42The Public Health and WelfareRelease 119-73

§300gg–16 Prohibition on discrimination in favor of highly compensated individuals

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–16

Last updated Apr 6, 2026|Official source

Summary

Group health plans that are not self-insured must follow rules that stop them from giving better benefits to highly paid workers. Certain related rules also apply, and the plan uses the same definition of "highly compensated individual" as in the related tax-code rules.

Full Legal Text

Title 42, §300gg–16

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

(a)A group health plan (other than a self-insured plan) shall satisfy the requirements of section 105(h)(2) of title 26 (relating to prohibition on discrimination in favor of highly compensated individuals).
(b)For purposes of this section—
(1)Rules similar to the rules contained in paragraphs (3), (4), and (8) of section 105(h) of title 26 shall apply.
(2)The term “highly compensated individual” has the meaning given such term by section 105(h)(5) of title 26.

Legislative History

Notes & Related Subsidiaries

Editorial Notes

Amendments

2010—Pub. L. 111–148, § 10101(d), amended section generally. Prior to amendment, text read as follows: “(a) In General.—The plan sponsor of a group health plan (other than a self-insured plan) may not establish rules relating to the health insurance coverage eligibility (including continued eligibility) of any full-time employee under the terms of the plan that are based on the total hourly or annual salary of the employee or otherwise establish eligibility rules that have the effect of discriminating in favor of higher wage employees. “(b) Limitation.—Subsection (a) shall not be construed to prohibit a plan sponsor from establishing contribution requirements for enrollment in the plan or coverage that provide for the payment by employees with lower hourly or annual compensation of a lower dollar or percentage contribution than the payment required of similarly situated employees with a higher hourly or annual compensation.”

Statutory Notes and Related Subsidiaries

Effective Date

Section effective for plan years beginning on or after the date that is 6 months after Mar. 23, 2010, see section 1004 of Pub. L. 111–148, set out as a note under section 300gg–11 of this title.

Reference

Citations & Metadata

Citation

42 U.S.C. § 300gg–16

Title 42The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73