§9832 Definitions

Summary

Defines key words used in the chapter about health coverage so people know what the terms mean. Group health plan — uses the legal definition in section 5000(b)(1). Health insurance coverage — means benefits for medical care provided through policies, plans, or HMOs, except for certain “excepted benefits.” Health insurance issuer — an insurer or similar organization licensed and regulated by a State; does not include a group health plan. Health maintenance organization — a federally qualified HMO, an HMO recognized under State law, or a similar State‑regulated organization. Excepted benefits — certain types of coverage that are not treated as regular medical benefits, including accident or disability income; supplements to liability; liability and auto liability; workers’ compensation; auto medical payments; credit‑only plans; on‑site clinic care; limited benefits like dental or vision, long‑term care and similar limited plans; specified‑disease or fixed‑indemnity policies offered independently; and Medicare supplemental, military supplemental, and similar supplemental policies. COBRA continuation provision — the continuation rules named in section 4980B (with a pediatric vaccine exception), Part 6 of subtitle B of title I of ERISA (except section 609), and Title XXII of the Public Health Service Act. Governmental plan — has the meaning in section 414(d). Medical care — uses the meaning in section 213(d) but without paragraph (1)(C) and excluding the part of paragraph (1)(D) about qualified long‑term care insurance. Network plan — coverage where care and payment are done, in whole or part, through a set of contracted providers. Placement for adoption — when a person takes legal responsibility for a child’s support pending adoption; that ends when the legal obligation ends. Family member — an individual’s dependent under section 9801(f)(2) and any 1st‑ through 4th‑degree relative of that person or their dependent. Genetic information — info about an individual’s genetic tests, family members’ genetic tests, or diseases showing up in family members; it also includes requests for or receipt of genetic services or participation in genetic 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; it excludes certain protein/metabolite tests that don’t detect those changes or that relate directly to an already‑manifested condition detectable by a trained clinician. Genetic services — genetic tests, genetic counseling, or genetic education. Underwriting purposes — rules or actions about eligibility, premium or contribution amounts, pre‑existing condition exclusions, and other activities tied to creating, renewing, or replacing health coverage.