§300gg–23 Preemption; State flexibility; construction

Summary

Federal health insurance rules usually do not replace state laws about insurers for individual or group coverage unless a state rule would stop a federal requirement from being applied. These federal rules also do not change the special federal rules that cover employer group health plans under 29 U.S.C. 1144. The law does not force a group health plan or insurer to offer particular benefits, except where section 2704 requires something. Federal rules about preexisting condition exclusions (see section 2701) override any state law that sets different rules for those exclusions. But for plans sold by insurers, states may do certain things instead, such as shorten the “6‑month” waiting period, shorten the 12‑ or 18‑month periods, allow more than 63 days for coverage gaps, allow more than a 30‑day enrollment window, ban exclusions beyond those in section 2701(d) or expand its exceptions, require extra special enrollment periods beyond section 2701(f), or reduce the maximum affiliation period under section 2701(g)(1)(B). “State law” means any state statute, rule, decision, or other state action (a U.S. law that applies only to D.C. counts as state law). “State” means a State (including the Northern Mariana Islands), its local governments, or their agencies.