§9832 — Title 26 Internal Revenue Code | U.S. Code

Summary

Defines many key words used in the chapter and explains what kinds of health plans and benefits are covered or not. It says where to look for a full meaning of some terms in other code sections. It also names which programs count as continuation coverage under COBRA. Group health plan: same meaning as in section 5000(b)(1). Health insurance coverage: mostly benefits that pay for medical care under insurance policies or HMO contracts, but not the excepted benefits listed below. Health insurance issuer: an insurer licensed and regulated by a State (does not include a group health plan). Health maintenance organization (HMO): a federally qualified HMO, a State-recognized HMO, or a similar State-regulated organization. Excepted benefits: several limited kinds of coverage such as accident or disability pay, liability supplements, workers’ compensation, auto medical payments, credit-only plans, on-site clinic coverage, limited dental or vision, long-term care or nursing-home care, specified disease or fixed indemnity plans, and Medicare or military supplemental coverage. COBRA continuation provision: includes section 4980B (except subsection (f)(1) as it relates to pediatric vaccines), Part 6 of subtitle B of title I of ERISA (29 U.S.C. 1161 et seq., except section 609), and Title XXII of the Public Health Service Act. Governmental plan: as defined in section 414(d). Medical care: as defined in section 213(d) but excluding paragraph (1)(C) and the part of paragraph (1)(D) about qualified long-term care insurance. Network plan: coverage using a set list of contracted providers. Placement for adoption: when someone takes legal responsibility for a child pending adoption. Family member: a dependent plus any 1st–4th degree relative. Genetic information: includes genetic tests, family test results, family disease signs, requests for or receipt of genetic services or participation in related research, but not sex or age. Genetic test: analysis that finds genotypes, mutations, or chromosome changes, with some protein/metabolite tests excluded. Genetic services: tests, counseling, or education. Underwriting purposes: rules about eligibility, premiums, pre-existing condition exclusions, and activities tied to creating, renewing, or replacing health coverage.

Title 26, §9832

Internal Revenue Code — Source: USLM XML via OLRC

(a)For purposes of this chapter, the term “group health plan” has the meaning given to such term by section 5000(b)(1).

(b)For purposes of this chapter—

(1)(A)Except as provided in subparagraph (B), the term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer.

(B)In applying subparagraph (A), excepted benefits described in subsection (c)(1) shall not be treated as benefits consisting of medical care.

(2)The term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section). Such term does not include a group health plan.

(3)The term “health maintenance organization” means—

(A)a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act (42 U.S.C. 300e(a))),

(B)an organization recognized under State law as a health maintenance organization, or

(C)a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization.

(c)For purposes of this chapter, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:

(1)(A)Coverage only for accident, or disability income insurance, or any combination thereof.

(B)Coverage issued as a supplement to liability insurance.

(C)Liability insurance, including general liability insurance and automobile liability insurance.

(D)Workers’ compensation or similar insurance.

(E)Automobile medical payment insurance.

(F)Credit-only insurance.

(G)Coverage for on-site medical clinics.

(H)Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

(2)(A)Limited scope dental or vision benefits.

(B)Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.

(C)Such other similar, limited benefits as are specified in regulations.

(3)(A)Coverage only for a specified disease or illness.

(B)Hospital indemnity or other fixed indemnity insurance.

(4)Medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social Security Act), coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code, and similar supplemental coverage provided to coverage under a group health plan.

(d)For purposes of this chapter—

(1)The term “COBRA continuation provision” means any of the following:

(A)section 4980B, other than subsection (f)(1) thereof insofar as it relates to pediatric vaccines.

(B)Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.), other than section 609 of such Act.

(C)Title XXII of the Public Health Service Act.

(2)The term “governmental plan” has the meaning given such term by section 414(d).

(3)The term “medical care” has the meaning given such term by section 213(d) determined without regard to—

(A)paragraph (1)(C) thereof, and

(B)so much of paragraph (1)(D) thereof as relates to qualified long-term care insurance.

(4)The term “network plan” means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the issuer.

(5)The term “placement”, or being “placed”, for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child’s placement with such person terminates upon the termination of such legal obligation.

(6)The term “family member” means, with respect to any individual—

(A)a dependent (as such term is used for purposes of section 9801(f)(2)) of such individual, and

(B)any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual or of an individual described in subparagraph (A).

(7)(A)The term “genetic information” means, with respect to any individual, information about—

(i)such individual’s genetic tests,

(ii)the genetic tests of family members of such individual, and

(iii)the manifestation of a disease or disorder in family members of such individual.

(B)Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.

(C)The term “genetic information” shall not include information about the sex or age of any individual.

(8)(A)The term “genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.

(B)The term “genetic test” does not mean—

(i)an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or

(ii)an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.

(9)The term “genetic services” means—

(A)a genetic test;

(B)genetic counseling (including obtaining, interpreting, or assessing genetic information); or

(C)genetic education.

(10)The term “underwriting purposes” means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan—

(A)rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage;

(B)the computation of premium or contribution amounts under the plan or coverage;

(C)the application of any pre-existing condition exclusion under the plan or coverage; and

(D)other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Employee Retirement Income Security Act of 1974, referred to in subsecs. (b)(2) and (d)(1)(B), is Pub. L. 93–406, Sept. 2, 1974, 88 Stat. 832. section 514(b)(2) of the Act is classified to section 1144(b)(2) of Title 29, Labor. section 609 of the Act is classified to section 1169 of Title 29. Part 6 of subtitle B of title I of the Act is classified generally to part 6 (§ 1161 et seq.) of subtitle B of subchapter I of chapter 18 of Title 29. For complete classification of this Act to the Code, see

Short Title

note set out under section 1001 of Title 29 and Tables. The date of the enactment of this section, referred to in subsec. (b)(2), is the date of enactment of Pub. L. 104–191, which was approved Aug. 21, 1996. section 1882(g)(1) of the Social Security Act, referred to in subsec. (c)(4), is classified to section 1395ss(g)(1) of Title 42, The Public Health and Welfare. The Public Health Service Act, referred to in subsec. (d)(1)(C), is act July 1, 1944, ch. 373, 58 Stat. 682. Title XXII of the Act is classified generally to subchapter XX (§ 300bb–1 et seq.) of chapter 6A of Title 42. For complete classification of this Act to the Code, see

Short Title

note set out under section 201 of Title 42 and Tables.

Amendments

2008—Subsec. (d)(6) to (10). Pub. L. 110–233 added pars. (6) to (10). 1997—Pub. L. 105–34 renumbered section 9805 of this title as this section.

Statutory Notes and Related Subsidiaries

Effective Date

of 2008 AmendmentAmendment by Pub. L. 110–233 applicable with respect to group health plans for plan years beginning after the date that is one year after May 21, 2008, see section 103(f)(2) of Pub. L. 110–233, set out as a note under section 9802 of this title.

Effective Date

Section applicable to plan years beginning after June 30, 1997, see section 401(c) of Pub. L. 104–191, set out as a note under section 9801 of this title.

§9832 Definitions

Summary

Title 26, §9832

Notes & Related Subsidiaries

Editorial Notes

References in Text

Short Title

Short Title

Amendments

Statutory Notes and Related Subsidiaries

Effective Date

Effective Date

Citations & Metadata