§18024 — Title 42 The Public Health and Welfare | U.S. Code

Summary

Sets plain meanings for words used in these health insurance rules. A "group market" is when people get health coverage through an employer’s group plan for themselves and their dependents. The "individual market" is coverage sold to people not through a group plan. "Large group market" and "small group market" mean group plans run by large or small employers. A "large employer" is one that averaged at least 51 employees on business days in the prior calendar year and has at least 1 employee on the first day of the plan year. A "small employer" averaged at least 1 but not more than 50 employees in the prior year and has at least 1 on the first day of the plan year. A State may choose to treat employers with 1–100 employees as small. Employers counted as one under federal tax rules are treated as a single employer. New employers are judged by how many employees they are reasonably expected to have this year. "Secretary" means the Secretary of Health and Human Services. "State" means the 50 States and the District of Columbia. An "educated health care consumer" is a person who knows about health care and can make informed health and medical choices.

Title 42, §18024

The Public Health and Welfare — Source: USLM XML via OLRC

(a)In this title: 11 See References in Text note below.

(1)The term “group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by an employer.

(2)The term “individual market” means the market for health insurance coverage offered to individuals other than in connection with a group health plan.

(3)The terms “large group market” and “small group market” mean the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer (as defined in subsection (b)(1)) or by a small employer (as defined in subsection (b)(2)), respectively.

(b)In this title: 1

(1)The term “large employer” means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.

(2)The term “small employer” means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 50 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.

(3)Notwithstanding paragraphs (1) and (2), nothing in this section shall prevent a State from applying this subsection by treating as a small employer, with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 100 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.

(4)For purposes of this subsection—

(A)All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of title 26 shall be treated as 1 employer.

(B)In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.

(C)Any reference in this subsection to an employer shall include a reference to any predecessor of such employer.

(D)If—

(i)a qualified employer that is a small employer makes enrollment in qualified health plans offered in the small group market available to its employees through an Exchange; and

(ii)the employer ceases to be a small employer by reason of an increase in the number of employees of such employer;

(c)In this title,1 the term “Secretary” means the Secretary of Health and Human Services.

(d)In this title,1 the term “State” means each of the 50 States and the District of Columbia.

(e)The term “educated health care consumer” means an individual who is knowledgeable about the health care system, and has background or experience in making informed decisions regarding health, medical, and scientific matters.

Notes & Related Subsidiaries

Editorial Notes

References in Text

This title, referred to in subsecs. (a) to (d), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

Amendments

2015—Subsec. (b)(1). Pub. L. 114–60, § 2(a)(1), substituted “51” for “101”. Subsec. (b)(2). Pub. L. 114–60, § 2(a)(2), substituted “50” for “100”. Subsec. (b)(3). Pub. L. 114–60, § 2(a)(3), amended par. (3) generally. Prior to amendment, text read as follows: “In the case of plan years beginning before January 1, 2016, a State may elect to apply this subsection by substituting ‘51 employees’ for ‘101 employees’ in paragraph (1) and by substituting ‘50 employees’ for ‘100 employees’ in paragraph (2).” 2010—Subsec. (e). Pub. L. 111–148, § 10104(d), added subsec. (e).

§18024 Related Definitions