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Title 29, LaborRelease 119-110

§1191b Definitions

Title 29 › CHAPTER 18 — EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › SUBCHAPTER I — PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle B — Regulatory Provisions › part 7 — group health plan requirements › Subpart C — General Provisions › § 1191b

Last updated Sep 22, 2026|Official source

Summary

Defines key words used for rules about group health plans and health insurance. Group health plan means an employee benefit plan that pays for medical care for workers or their dependents. Medical care means payments for finding, treating, preventing, or affecting a medical condition, for necessary transport to get that care, and for insurance that pays for those things. Health insurance coverage means medical care benefits offered by an insurer or HMO. Health insurance issuer means a licensed insurance company or organization, not a group health plan. Health maintenance organization means an HMO recognized under federal or state law. Group health insurance coverage means insurance offered with a group health plan. Excepted benefits are certain kinds of coverage that are mostly outside these rules, such as accident-only or disability pay, some liability or workers’ comp coverages, limited dental or vision, long-term care or nursing-home services, disease-specific or fixed indemnity plans, and Medicare or similar supplemental policies. Also defines other terms used in the rules. COBRA continuation provision means the laws that allow people to keep coverage after certain events. Health status-related factor means things about a person’s health used in other rules. Network plan means coverage that uses a set list of contracted providers. Placement for adoption uses the meaning from another part of the law. Family member means certain dependents and relatives up to fourth degree. Genetic information covers genetic tests, family test results, signs of disease in family members, requests for genetic services or participation in genetic research, but not sex or age. Genetic test means analysis of DNA, RNA, chromosomes, proteins, or metabolites that finds genes, mutations, or chromosomal changes, with some narrow exceptions. Genetic services means tests, counseling, or education. Underwriting purposes means rules about eligibility, premiums, preexisting conditions, and other actions tied to creating or renewing coverage.

Full Legal Text

Title 29, §1191b

Labor, Source: USLM XML via OLRC

(a)Group health plan
For purposes of this part—
(1)In general
The term “group health plan” means an employee welfare benefit plan to the extent that the plan provides medical care (as defined in paragraph (2) and including items and services paid for as medical care) to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Such term shall not include any qualified small employer health reimbursement arrangement (as defined in section 9831(d)(2) of title 26).
(2)Medical care
The term “medical care” means amounts paid for— (A)
(B)amounts paid for transportation primarily for and essential to medical care referred to in subparagraph (A), and
(C)amounts paid for insurance covering medical care referred to in subparagraphs (A) and (B).
(b)Definitions relating to health insurance
For purposes of this part—
(1)Health insurance coverage
The term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) 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.
(2)Health insurance issuer
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 1144(b)(2) of this title). Such term does not include a group health plan.
(3)Health maintenance organization
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.
(4)Group health insurance coverage
The term “group health insurance coverage” means, in connection with a group health plan, health insurance coverage offered in connection with such plan.
(c)Excepted benefits
For purposes of this part, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:
(1)Benefits not subject to requirements
(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)Benefits not subject to requirements if offered separately
(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)Benefits not subject to requirements if offered as independent, noncoordinated benefits
(A)Coverage only for a specified disease or illness.
(B)Hospital indemnity or other fixed indemnity insurance.
(4)Benefits not subject to requirements if offered as separate insurance policy
Medicare supplemental health insurance (as defined under section 1395ss(g)(1) of title 42), coverage supplemental to the coverage provided under chapter 55 of title 10, and similar supplemental coverage provided to coverage under a group health plan.
(d)Other definitions
For purposes of this part—
(1)COBRA continuation provision
The term “COBRA continuation provision” means any of the following:
(A)Part 6 of this subtitle.
(B)Section 4980B of title 26, other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines.
(C)Title XXII of the Public Health Service Act [42 U.S.C. 300bb–1 et seq.].
(2)Health status-related factor (3) Network plan
The term “health status-related factor” means any of the factors described in section 1182(a)(1) of this title.
(4)Placed for adoption
The term “placement”, or being “placed”, for adoption, has the meaning given such term in section 1169(c)(3)(B) of this title.
(5)Family member
The term “family member” means, with respect to an individual—
(A)a dependent (as such term is used for purposes of section 1181(f)(2) of this title) 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).
(6)Genetic information
(A)In general
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)Inclusion of genetic services and participation in genetic research
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)Exclusions
The term “genetic information” shall not include information about the sex or age of any individual.
(7)Genetic test
(A)In general
The term “genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.
(B)Exceptions
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.
(8)Genetic services
The term “genetic services” means—
(A)a genetic test;
(B)genetic counseling (including obtaining, interpreting, or assessing genetic information); or
(C)genetic education.
(9)Underwriting purposes
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.

Legislative History

Notes & Related Subsidiaries

Editorial Notes

References in Text

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, The Public Health and Welfare. For complete classification of this Act to the Code, see

Short Title

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

Amendments

2016—Subsec. (a)(1). Pub. L. 114–255 inserted at end “Such term shall not include any qualified small employer health reimbursement arrangement (as defined in section 9831(d)(2) of title 26).” 2008—Subsec. (d)(5) to (9). Pub. L. 110–233 added pars. (5) to (9).

Statutory Notes and Related Subsidiaries

Effective Date

of 2016 AmendmentAmendment by Pub. L. 114–255 applicable to plan years beginning after Dec. 31, 2016, see section 18001(b)(3) of Pub. L. 114–255, set out as a note under section 1167 of this title.

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 101(f)(2) of Pub. L. 110–233, set out as a note under section 1132 of this title.

Effective Date

Section applicable with respect to group health plans for plan years beginning after June 30, 1997, except as otherwise provided, see section 101(g) of Pub. L. 104–191, set out as a note under section 1181 of this title.

Reference

Citations & Metadata

Citation

29 U.S.C. § 1191b

Title 29, Labor

Last Updated

Sep 22, 2026

Release point: 119-110