26 U.S.C. § 9815: Additional market reforms

§ 54.9815-1251 Preservation of right to maintain existing coverage.§ 54.9815-2704 Prohibition of preexisting condition exclusions.§ 54.9815-2705 Prohibiting discrimination against participants and beneficiaries based on a health factor.§ 54.9815-2708 Prohibition on waiting periods that exceed 90 days.§ 54.9815-2711 No lifetime or annual limits.§ 54.9815-2712 Rules regarding rescissions.§ 54.9815-2713 Coverage of preventive health services.§ 54.9815-2713T Coverage of preventive health services (temporary).§ 54.9815-2713A Accommodations in connection with coverage of preventive health services.§ 54.9815-2714 Eligibility of children until at least age 26.§ 54.9815-2715 Summary of benefits and coverage and uniform glossary.§ 54.9815-2715A1 Transparency in coverage—definitions.§ 54.9815-2715A2 Transparency in coverage—required disclosures to participants and beneficiaries.§ 54.9815-2715A3 Transparency in coverage—requirements for public disclosure.§ 54.9815-2719 Internal claims and appeals and external review processes.§ 54.9815-2719T Internal claims and appeals and external review processes (temporary).§ 54.9815-2719A Patient protections.§ 54.9815-2719AT Patient protections (temporary).Prop. § 54.9815-2719T Proposed 2013 · Internal claims and appeals and external review processes.Prop. § 54.9815-2713T Proposed 2017 · [Amended]Prop. § 54.9815-2713 Proposed 2020 · Coverage of preventive health services.Prop. § 54.9815-2719A Proposed 2021 · Patient protections.Prop. § 54.9815-2719 Proposed 2021 · Internal claims and appeals and external review processes.

Forms: Form 5500

Final rules 30

(a) General rule Except as provided in subsection (b)—

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(1) the provisions of part A of title XXVII of the Public Health Service Act (as amended by the Patient Protection and Affordable Care Act) shall apply to group health plans, and health insurance issuers providing health insurance coverage in connection with group health plans, as if included in this subchapter; and

(2) to the extent that any provision of this subchapter conflicts with a provision of such part A with respect to group health plans, or health insurance issuers providing health insurance coverage in connection with group health plans, the provisions of such part A shall apply.

(b) Exception Notwithstanding subsection (a), the provisions of sections 2716 and 2718 of title XXVII of the Public Health Service Act (as amended by the Patient Protection and Affordable Care Act) shall not apply with respect to self-insured group health plans, and the provisions of this subchapter shall continue to apply to such plans as if such sections of the Public Health Service Act (as so amended) had not been enacted.

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