Title 42, The Public Health and WelfareRelease 119-110
§300gg–22 Enforcement
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–22
Summary
States may make health insurers follow the rules in this part and related part D (except for one specific rule, section 300gg–121). If the federal Secretary finds a State is not really enforcing those rules, the Secretary will step in and enforce them for how coverage is sold, issued, renewed, or offered in that State. When the Secretary enforces, the rules cover individual plans and non‑Federal government group plans. If an issuer or such a plan breaks the rules, they can be fined. The usual fine is up to $100 each day for each person affected. The Secretary will look at past compliance and how serious the problem was when setting the amount. No fine will be charged if the violator did not know and could not have known the problem with reasonable diligence, or if the problem was fixed within 30 days after they knew (and the problem was from a reasonable cause, not willful neglect). The fined party can ask for a hearing within 30 days of the notice. After a hearing they can appeal to federal court within 30 days and the Secretary must file the case record. If the fined party still does not pay after final orders, the Attorney General will sue to collect, and the order’s validity cannot be re‑litigated in that collection suit. Money collected goes to the Secretary to be used to enforce these rules. Special rules apply for genetic‑information violations: the fine is $100 per day per affected person during the time of the violation, with minimums of $2,500 per person (or $15,000 per person if violations are more than de minimis). The same discovery and 30‑day correction rules apply, and for unintentional failures the total fine cannot exceed the lesser of 10 percent of the employer’s prior‑year group health spending or $500,000. The Secretary may waive part or all of a penalty if it would be excessive for a reasonable, non‑willful mistake.
Full Legal Text
Title 42, §300gg–22
The Public Health and Welfare, Source: USLM XML via OLRC
(a)State enforcement
(1)State authority
Subject to section 300gg–23 of this title, each State may require that health insurance issuers that issue, sell, renew, or offer health insurance coverage in the State in the individual or group market meet the requirements of this part and part D (other than section 300gg–121 of this title) with respect to such issuers.
(2)Failure to implement provisions
In the case of a determination by the Secretary that a State has failed to substantially enforce a provision (or provisions) in this part or part D (other than section 300gg–121 of this title) with respect to health insurance issuers in the State, the Secretary shall enforce such provision (or provisions) under subsection (b) insofar as they relate to the issuance, sale, renewal, and offering of health insurance coverage in connection with group health plans or individual health insurance coverage in such State.
(b)Secretarial enforcement authority
(1)Limitation
The provisions of this subsection shall apply to enforcement of a provision (or provisions) of this part or part D (other than section 300gg–121 of this title) only—
(A)as provided under subsection (a)(2); and
(B)with respect to individual health insurance coverage or group health plans that are non-Federal governmental plans.
(2)Imposition of penalties
In the cases described in paragraph (1)—
(A)In general
Subject to the succeeding provisions of this subsection, any non-Federal governmental plan that is a group health plan and any health insurance issuer that fails to meet a provision of this part or part D (other than section 300gg–121 of this title) applicable to such plan or issuer is subject to a civil money penalty under this subsection.
(B)Liability for penalty
In the case of a failure by—
(i)a health insurance issuer, the issuer is liable for such penalty, or
(ii)a group health plan that is a non-Federal governmental plan which is—
(I)sponsored by 2 or more employers, the plan is liable for such penalty, or
(II)not so sponsored, the employer is liable for such penalty.
(C)Amount of penalty
(i)In general
The maximum amount of penalty imposed under this paragraph is $100 for each day for each individual with respect to which such a failure occurs.
(ii)Considerations in imposition
In determining the amount of any penalty to be assessed under this paragraph, the Secretary shall take into account the previous record of compliance of the entity being assessed with the applicable provisions of this part and part D (other than section 300gg–121 of this title) and the gravity of the violation.
(iii)Limitations
(I)Penalty not to apply where failure not discovered exercising reasonable diligence
No civil money penalty shall be imposed under this paragraph on any failure during any period for which it is established to the satisfaction of the Secretary that none of the entities against whom the penalty would be imposed knew, or exercising reasonable diligence would have known, that such failure existed.
(II)Penalty not to apply to failures corrected within 30 days
No civil money penalty shall be imposed under this paragraph on any failure if such failure was due to reasonable cause and not to willful neglect, and such failure is corrected during the 30-day period beginning on the first day any of the entities against whom the penalty would be imposed knew, or exercising reasonable diligence would have known, that such failure existed.
(D)Administrative review
(i)Opportunity for hearing
The entity assessed shall be afforded an opportunity for hearing by the Secretary upon request made within 30 days after the date of the issuance of a notice of assessment. In such hearing the decision shall be made on the record pursuant to section 554 of title 5. If no hearing is requested, the assessment shall constitute a final and unappealable order.
(ii)Hearing procedure
If a hearing is requested, the initial agency decision shall be made by an administrative law judge, and such decision shall become the final order unless the Secretary modifies or vacates the decision. Notice of intent to modify or vacate the decision of the administrative law judge shall be issued to the parties within 30 days after the date of the decision of the judge. A final order which takes effect under this paragraph shall be subject to review only as provided under subparagraph (E).
(E)Judicial review
(i)Filing of action for review
Any entity against whom an order imposing a civil money penalty has been entered after an agency hearing under this paragraph may obtain review by the United States district court for any district in which such entity is located or the United States District Court for the District of Columbia by filing a notice of appeal in such court within 30 days from the date of such order, and simultaneously sending a copy of such notice by registered mail to the Secretary.
(ii)Certification of administrative record
The Secretary shall promptly certify and file in such court the record upon which the penalty was imposed.
(iii)Standard for review
The findings of the Secretary shall be set aside only if found to be unsupported by substantial evidence as provided by section 706(2)(E) of title 5.
(iv)Appeal
Any final decision, order, or judgment of the district court concerning such review shall be subject to appeal as provided in chapter 83 of title 28.
(F)Failure to pay assessment; maintenance of action
(i)Failure to pay assessment
If any entity fails to pay an assessment after it has become a final and unappealable order, or after the court has entered final judgment in favor of the Secretary, the Secretary shall refer the matter to the Attorney General who shall recover the amount assessed by action in the appropriate United States district court.
(ii)Nonreviewability
In such action the validity and appropriateness of the final order imposing the penalty shall not be subject to review.
(G)Payment of penalties
Except as otherwise provided, penalties collected under this paragraph shall be paid to the Secretary (or other officer) imposing the penalty and shall be available without appropriation and until expended for the purpose of enforcing the provisions with respect to which the penalty was imposed.
(3)Enforcement authority relating to genetic discrimination
(A)General rule
In the cases described in paragraph (1), notwithstanding the provisions of paragraph (2)(C), the succeeding subparagraphs of this paragraph shall apply with respect to an action under this subsection by the Secretary with respect to any failure of a health insurance issuer in connection with a group health plan, to meet the requirements of subsection (a)(1)(F), (b)(3), (c), or (d) of section 2702 1 or section 2701 1 or 2702(b)(1) 1 with respect to genetic information in connection with the plan.
(B)Amount
(i)In general
The amount of the penalty imposed under this paragraph shall be $100 for each day in the noncompliance period with respect to each participant or beneficiary to whom such failure relates.
(ii)Noncompliance period
For purposes of this paragraph, the term “noncompliance period” means, with respect to any failure, the period—
(I)beginning on the date such failure first occurs; and
(II)ending on the date the failure is corrected.
(C)Minimum penalties where failure discovered
Notwithstanding clauses (i) and (ii) of subparagraph (D):
(i)In general
In the case of 1 or more failures with respect to an individual—
(I)which are not corrected before the date on which the plan receives a notice from the Secretary of such violation; and
(II)which occurred or continued during the period involved;
the amount of penalty imposed by subparagraph (A) by reason of such failures with respect to such individual shall not be less than $2,500.
(ii)Higher minimum penalty where violations are more than de minimis
To the extent violations for which any person is liable under this paragraph for any year are more than de minimis, clause (i) shall be applied by substituting “$15,000” for “$2,500” with respect to such person.
(D)Limitations
(i)Penalty not to apply where failure not discovered exercising reasonable diligence
No penalty shall be imposed by subparagraph (A) on any failure during any period for which it is established to the satisfaction of the Secretary that the person otherwise liable for such penalty did not know, and exercising reasonable diligence would not have known, that such failure existed.
(ii)Penalty not to apply to failures corrected within certain periods
No penalty shall be imposed by subparagraph (A) on any failure if—
(I)such failure was due to reasonable cause and not to willful neglect; and
(II)such failure is corrected during the 30-day period beginning on the first date the person otherwise liable for such penalty knew, or exercising reasonable diligence would have known, that such failure existed.
(iii)Overall limitation for unintentional failures
In the case of failures which are due to reasonable cause and not to willful neglect, the penalty imposed by subparagraph (A) for failures shall not exceed the amount equal to the lesser of— (I)
(II)$500,000.
(E)Waiver by Secretary
In the case of a failure which is due to reasonable cause and not to willful neglect, the Secretary may waive part or all of the penalty imposed by subparagraph (A) to the extent that the payment of such penalty would be excessive relative to the failure involved.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
section 300gg–23 of this title, referred to in subsec. (a)(1), was in the original section “2723”, and was translated as meaning section 2724 of act
July 1, 1944, to reflect the probable intent of Congress and the renumbering of section 2723 as 2724 by Pub. L. 111–148, title I, §§ 1001(4), 1563(c)(14)(B), formerly § 1562(c)(14)(B), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 130, 269, 911. section 2702, referred to in subsec. (b)(3)(A), is a reference to section 2702 of act
July 1, 1944. section 2702, which was classified to section 300gg–1 of this title, was amended by Pub. L. 111–148, title I, § 1201(3), Mar. 23, 2010, 124 Stat. 154, and was transferred to subsecs. (b) to (f) of section 300gg–4 of this title, effective for plan years beginning on or after Jan. 1, 2014. A new section 2702, related to guaranteed availability of coverage, was added by Pub. L. 111–148, title I, § 1201(4), Mar. 23, 2010, 124 Stat. 156, effective for plan years beginning on or after Jan. 1, 2014, and is classified to section 300gg–1 of this title. section 2701, referred to in subsec. (b)(3)(A), 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.
Prior Provisions
A prior section 2723 of act July 1, 1944, was renumbered section 2724 and is classified to section 300gg–23 of this title.
Amendments
2026—Pub. L. 119–75 inserted “(other than section 300gg–121 of this title” after “part D” wherever appearing. 2020—Subsec. (a)(1). Pub. L. 116–260, § 102(a)(3)(C)(i), inserted “and part D” after “this part”. Subsecs. (a)(2), (b)(1), (2)(A). Pub. L. 116–260, § 102(a)(3)(C)(ii)–(iv), inserted “or part D” after “this part”. Subsec. (b)(2)(C)(ii). Pub. L. 116–260, § 102(a)(3)(C)(v), inserted “and part D” after “this part”. 2010—Subsec. (a)(1). Pub. L. 111–148, § 1563(c)(13)(A)(i), formerly § 1562(c)(13)(A)(i), as renumbered by Pub. L. 111–148, § 10107(b)(1), substituted “individual or group market” for “small or large group markets”. Subsec. (a)(2). Pub. L. 111–148, § 1563(c)(13)(a)(ii), formerly § 1562(c)(13)(A)(ii), as renumbered by Pub. L. 111–148, § 10107(b)(1), inserted “or individual health insurance coverage” after “group health plans”. Subsec. (b)(1)(B). Pub. L. 111–148, § 1563(c)(13)(B), formerly § 1562(c)(13)(B), as renumbered by Pub. L. 111–148, § 10107(b)(1), inserted “individual health insurance coverage or” after “with respect to”. 2008—Subsec. (b)(3). Pub. L. 110–233 added par. (3).
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 2008 AmendmentAmendment by Pub. L. 110–233 applicable, with respect to group health plans and health insurance coverage offered in connection with group health plans, for plan years beginning after the date that is one year after
May 21, 2008, and, with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market, after the date that is one year after
May 21, 2008, see section 102(d)(2) of Pub. L. 110–233, set out as a note under section 300gg–21 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–22
Title 42, The Public Health and Welfare
Last Updated
Sep 23, 2026
Release point: 119-110