§1191a Special Rules Relating to Group Health Plans

Summary

Most of the rules in this part do not apply to certain small group health plans and to some limited kinds of benefits. If on the first day of a plan year a group health plan has fewer than 2 participants who are current employees, the rules here (except for sections 1185 and 1185o) do not apply for that year. The rules also do not apply when the plan only offers the excepted benefits named in section 1191b(c)(1). Other excepted benefits named in section 1191b(c) are exempt only under certain conditions: limited excepted benefits (1191b(c)(2)) are exempt if they are under a separate policy or are not an integral part of the plan; noncoordinated excepted benefits (1191b(c)(3)) are exempt only if they are under a separate policy, do not coordinate with any exclusions in another plan by the same sponsor, and pay for an event regardless of whether another plan pays; supplemental excepted benefits (1191b(c)(4)) are exempt if provided under a separate policy. When a partnership creates a plan, fund, or program that provides medical care to present or former partners or their dependents, that program is treated as a group health plan under these rules. The partnership is treated as the employer for each partner. A partner (and a self‑employed person who might get benefits from a plan that covers employees) is treated as a participant if they can become eligible for benefits.