§1191 Preemption; State Flexibility; Construction

Summary

Federal rules mostly let state laws about group health insurance stay in place. A state law that only applies to insurance companies and group coverage will continue unless it stops a federal rule here from being used. Nothing here changes how section 1144 applies to group health plans. For coverage sold by an insurer, the federal rules about preexisting condition exclusions in section 1181 override any state law that conflicts. But state law is not overridden if it does any of these: replaces the “6-month period” with a shorter time; replaces “12 months” or “18 months” with a shorter time; changes the “63 days” or the “30-day period” to a longer number of days; bans certain preexisting condition exclusions or widens exceptions; requires extra special enrollment periods; or shortens the maximum affiliation period in section 1181. “State law” means any state statute, decision, rule, regulation, or other state action (laws for the District of Columbia count as state law). “State” includes a State, the Northern Mariana Islands, their local governments, and their agencies. Except as section 1185 says, no rule here forces a group plan or insurance policy to provide particular benefits.