Title 42, The Public Health and WelfareRelease 119-110
§300gg–23 Preemption; State Flexibility; Construction
Title 42 › CHAPTER 6A — PUBLIC HEALTH SERVICE › SUBCHAPTER XXV — REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE › Part A — Individual and Group Market Reforms › Subpart 2 — Exclusion of Plans; Enforcement; Preemption › § 300gg–23
Summary
State rules about health insurance companies keep working unless they stop a federal rule from being applied. State laws that only affect insurers and their individual or group policies stay in force, except where they conflict with the federal requirements. This does not change the separate federal rules that govern group health plans. For limits on preexisting condition exclusions, federal rules for coverage sold by insurers usually override state rules that differ. But states can make some changes: they can shorten the 6-month period, shorten the 12‑month and 18‑month periods, allow more than 63 days for certain gaps, allow longer than a 30‑day period where noted, stop exclusions in more situations or widen the exceptions, add extra special enrollment periods, or shorten the maximum affiliation period. The law also does not force a plan or policy to cover any particular benefit. State law: any state law, rule, decision, or similar action (and a U.S. law that applies only to the District of Columbia is treated the same). State: a state (including the Northern Mariana Islands), its local governments, or their agencies.
Full Legal Text
Title 42, §300gg–23
The Public Health and Welfare, Source: USLM XML via OLRC
(a)Continued applicability of State law with respect to health insurance issuers
(1)In general
Subject to paragraph (2) and except as provided in subsection (b), this part, part D, and part C insofar as it relates to this part or part D shall not be construed to supersede any provision of State law which establishes, implements, or continues in effect any standard or requirement solely relating to health insurance issuers in connection with individual or group health insurance coverage except to the extent that such standard or requirement prevents the application of a requirement of this part or part D.
(2)Continued preemption with respect to group health plans
Nothing in this part or part D shall be construed to affect or modify the provisions of section 1144 of title 29 with respect to group health plans.
(b)Special rules in case of portability requirements
(1)In general
Subject to paragraph (2), the provisions of this part relating to health insurance coverage offered by a health insurance issuer supersede any provision of State law which establishes, implements, or continues in effect a standard or requirement applicable to imposition of a preexisting condition exclusion specifically governed by section 701 which differs from the standards or requirements specified in such section.
(2)Exceptions
Only in relation to health insurance coverage offered by a health insurance issuer, the provisions of this part do not supersede any provision of State law to the extent that such provision—
(i)substitutes for the reference to “6-month period” in section 2701(a)(1) 1 a reference to any shorter period of time;
(ii)substitutes for the reference to “12 months” and “18 months” in section 2701(a)(2) 1 a reference to any shorter period of time;
(iii)substitutes for the references to “63” days in section 2701(c)(2)(A) 1 and 2701(d)(4)(A) 1 a reference to any greater number of days;
(iv)substitutes for the reference to “30-day period” in section 2701(b)(2) 1 and 2701(d)(1) 1 a reference to any greater period;
(v)prohibits the imposition of any preexisting condition exclusion in cases not described in section 2701(d) 1 or expands the exceptions described in such section;
(vi)requires special enrollment periods in addition to those required under section 2701(f) 1; or
(vii)reduces the maximum period permitted in an affiliation period under section 2701(g)(1)(B) 1.
(c)Rules of construction
Nothing in this part (other than section 2704) 1 or part D shall be construed as requiring a group health plan or health insurance coverage to provide specific benefits under the terms of such plan or coverage.
(d)Definitions
For purposes of this section
(1) State law
(2)State
The term “State” includes a State (including the Northern Mariana Islands), any political subdivisions of a State or such Islands, or any agency or instrumentality of either.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
section 2701, referred to in subsec. (b), is a reference to section 2701 of act
July 1, 1944. section 2701, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg–3 of this title. A new section 2701 of act
July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title. section 701, referred to in subsec. (b)(1), probably means “section 2701” of act
July 1, 1944. See note above. section 2704, referred to in subsec. (c), is a reference to section 2704 of act
July 1, 1944. section 2704, which was classified to section 300gg–4 of this title, was renumbered section 2725, and amended by Pub. L. 111–148, title I, §§ 1001(2), 1563(c)(3), formerly § 1562(c)(3), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 130, 265, 911, and was transferred to section 300gg–25 of this title. A new section 2704 of act
July 1, 1944, related to prohibition of preexisting condition exclusions or other discrimination based on health status, was added, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and is classified to section 300gg–3 of this title.
Amendments
2020—Subsec. (a)(1). Pub. L. 116–260, § 102(a)(3)(D)(i), substituted “this part, part D, and part C insofar as it relates to this part or part D” for “this part and part C insofar as it relates to this part” and inserted “or part D” before period at end. Subsec. (a)(2). Pub. L. 116–260, § 102(a)(3)(D)(ii), inserted “or part D” after “this part”. Subsec. (c). Pub. L. 116–260, § 102(a)(3)(D)(iii), inserted “or part D” after “this part (other than section 2704)”. 2010—Subsec. (a)(1). Pub. L. 111–148, § 1563(c)(14)(A), formerly § 1562(c)(14)(A), as renumbered by Pub. L. 111–148, § 10107(b)(1), inserted “individual or” before “group health insurance”. 1996—Subsec. (c). Pub. L. 104–204 inserted “(other than section 2704)” after “part”.
Statutory Notes and Related Subsidiaries
Effective Date
of 2020 AmendmentAmendment by Pub. L. 116–260 applicable with respect to plan years beginning on or after Jan. 1, 2022, see section 102(e) of div. BB of Pub. L. 116–260, set out as a note under section 8902 of Title 5, Government Organization and Employees.
Effective Date
of 1996 AmendmentAmendment by Pub. L. 104–204 applicable with respect to group health plans for plan years beginning on or after Jan. 1, 1998, see section 604(c) of Pub. L. 104–204 set out as an
Effective Date
note under section 300gg–25 of this title.
Effective Date
Section applicable with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997, except as otherwise provided, see section 102(c) of Pub. L. 104–191, set out as a note under section 300gg of this title.
Reference
Citations & Metadata
Citation
42 U.S.C. § 300gg–23
Title 42, The Public Health and Welfare
Last Updated
Sep 23, 2026
Release point: 119-110