# 26 U.S.C. § 9815: Additional market reforms Source: OLRC release point 119-134 . Cite pinpoints as 26 U.S.C. § 9815(a)(1). ## § 9815(a) General rule Except as provided in subsection (b)— **§ 9815(a)(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 **§ 9815(a)(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. ## § 9815(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. ## Regulations - [Treas. Reg. § 54.9815-1251](/26/reg/54.9815-1251.md): Preservation of right to maintain existing coverage. (interprets § 9815) - [Treas. Reg. § 54.9815-2704](/26/reg/54.9815-2704.md): Prohibition of preexisting condition exclusions. (interprets § 9815) - [Treas. Reg. § 54.9815-2705](/26/reg/54.9815-2705.md): Prohibiting discrimination against participants and beneficiaries based on a health factor. (interprets § 9815) - [Treas. Reg. § 54.9815-2708](/26/reg/54.9815-2708.md): Prohibition on waiting periods that exceed 90 days. (interprets § 9815) - [Treas. Reg. § 54.9815-2711](/26/reg/54.9815-2711.md): No lifetime or annual limits. (interprets § 9815) - [Treas. Reg. § 54.9815-2712](/26/reg/54.9815-2712.md): Rules regarding rescissions. (interprets § 9815) - [Treas. Reg. § 54.9815-2713](/26/reg/54.9815-2713.md): Coverage of preventive health services. (interprets § 9815) - [Treas. Reg. § 54.9815-2713T](/26/reg/54.9815-2713T.md): Coverage of preventive health services (temporary). (interprets § 9815) - [Treas. Reg. § 54.9815-2713A](/26/reg/54.9815-2713A.md): Accommodations in connection with coverage of preventive health services. (interprets § 9815) - [Treas. Reg. § 54.9815-2714](/26/reg/54.9815-2714.md): Eligibility of children until at least age 26. (interprets § 9815) - [Treas. Reg. § 54.9815-2715](/26/reg/54.9815-2715.md): Summary of benefits and coverage and uniform glossary. (interprets § 9815) - [Treas. Reg. § 54.9815-2715A1](/26/reg/54.9815-2715A1.md): Transparency in coverage—definitions. (interprets § 9815) - [Treas. Reg. § 54.9815-2715A2](/26/reg/54.9815-2715A2.md): Transparency in coverage—required disclosures to participants and beneficiaries. (interprets § 9815) - [Treas. Reg. § 54.9815-2715A3](/26/reg/54.9815-2715A3.md): Transparency in coverage—requirements for public disclosure. (interprets § 9815) - [Treas. Reg. § 54.9815-2719](/26/reg/54.9815-2719.md): Internal claims and appeals and external review processes. (interprets § 9815) - [Treas. Reg. § 54.9815-2719T](/26/reg/54.9815-2719T.md): Internal claims and appeals and external review processes (temporary). (interprets § 9815) - [Treas. Reg. § 54.9815-2719A](/26/reg/54.9815-2719A.md): Patient protections. (interprets § 9815) - [Treas. Reg. § 54.9815-2719AT](/26/reg/54.9815-2719AT.md): Patient protections (temporary). (interprets § 9815) ## Forms named in the regulations - [Form 5500](https://www.irs.gov/pub/irs-pdf/f5500.pdf) ## Final rules - [91 FR 63748](https://www.federalregister.gov/documents/2026/10/06/2026-20447/transparency-in-coverage) (2026): Transparency in Coverage - [86 FR 55980](https://www.federalregister.gov/documents/2021/10/07/2021-21441/requirements-related-to-surprise-billing-part-ii) (2021): Requirements Related to Surprise Billing; Part II - [86 FR 36872](https://www.federalregister.gov/documents/2021/07/13/2021-14379/requirements-related-to-surprise-billing-part-i) (2021): Requirements Related to Surprise Billing; Part I - [85 FR 81097](https://www.federalregister.gov/documents/2020/12/15/2020-27498/grandfathered-group-health-plans-and-grandfathered-group-health-insurance-coverage) (2020): Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage - [85 FR 72158](https://www.federalregister.gov/documents/2020/11/12/2020-24591/transparency-in-coverage) (2020): Transparency in Coverage - [85 FR 71142](https://www.federalregister.gov/documents/2020/11/06/2020-24332/additional-policy-and-regulatory-revisions-in-response-to-the-covid-19-public-health-emergency) (2020): Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency - [84 FR 28888](https://www.federalregister.gov/documents/2019/06/20/2019-12571/health-reimbursement-arrangements-and-other-account-based-group-health-plans) (2019): Health Reimbursement Arrangements and Other Account-Based Group Health Plans - [83 FR 57592](https://www.federalregister.gov/documents/2018/11/15/2018-24514/moral-exemptions-and-accommodations-for-coverage-of-certain-preventive-services-under-the-affordable) (2018): Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act - [83 FR 57536](https://www.federalregister.gov/documents/2018/11/15/2018-24512/religious-exemptions-and-accommodations-for-coverage-of-certain-preventive-services-under-the) (2018): Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act - [82 FR 47838](https://www.federalregister.gov/documents/2017/10/13/2017-21852/moral-exemptions-and-accommodations-for-coverage-of-certain-preventive-services-under-the-affordable) (2017): Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act - [82 FR 47792](https://www.federalregister.gov/documents/2017/10/13/2017-21851/religious-exemptions-and-accommodations-for-coverage-of-certain-preventive-services-under-the) (2017): Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act - [81 FR 75316](https://www.federalregister.gov/documents/2016/10/31/2016-26162/excepted-benefits-lifetime-and-annual-limits-and-short-term-limited-duration-insurance) (2016): Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance - [80 FR 72192](https://www.federalregister.gov/documents/2015/11/18/2015-29294/final-rules-for-grandfathered-plans-preexisting-condition-exclusions-lifetime-and-annual-limits) (2015): Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act - [80 FR 41318](https://www.federalregister.gov/documents/2015/07/14/2015-17076/coverage-of-certain-preventive-services-under-the-affordable-care-act) (2015): Coverage of Certain Preventive Services Under the Affordable Care Act - [80 FR 34292](https://www.federalregister.gov/documents/2015/06/16/2015-14559/summary-of-benefits-and-coverage-and-uniform-glossary) (2015): Summary of Benefits and Coverage and Uniform Glossary - [79 FR 51092](https://www.federalregister.gov/documents/2014/08/27/2014-20252/coverage-of-certain-preventive-services-under-the-affordable-care-act) (2014): Coverage of Certain Preventive Services Under the Affordable Care Act - [79 FR 35942](https://www.federalregister.gov/documents/2014/06/25/2014-14795/ninety-day-waiting-period-limitation) (2014): Ninety-Day Waiting Period Limitation - [79 FR 10296](https://www.federalregister.gov/documents/2014/02/24/2014-03809/ninety-day-waiting-period-limitation-and-technical-amendments-to-certain-health-coverage) (2014): Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act - [78 FR 39870](https://www.federalregister.gov/documents/2013/07/02/2013-15866/coverage-of-certain-preventive-services-under-the-affordable-care-act) (2013): Coverage of Certain Preventive Services Under the Affordable Care Act - [78 FR 33158](https://www.federalregister.gov/documents/2013/06/03/2013-12916/incentives-for-nondiscriminatory-wellness-programs-in-group-health-plans) (2013): Incentives for Nondiscriminatory Wellness Programs in Group Health Plans - [77 FR 8725](https://www.federalregister.gov/documents/2012/02/15/2012-3547/group-health-plans-and-health-insurance-issuers-relating-to-coverage-of-preventive-services-under) (2012): Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act - [77 FR 8668](https://www.federalregister.gov/documents/2012/02/14/2012-3228/summary-of-benefits-and-coverage-and-uniform-glossary) (2012): Summary of Benefits and Coverage and Uniform Glossary - [76 FR 46621](https://www.federalregister.gov/documents/2011/08/03/2011-19684/group-health-plans-and-health-insurance-issuers-relating-to-coverage-of-preventive-services-under) (2011): Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act - [76 FR 37208](https://www.federalregister.gov/documents/2011/06/24/2011-15890/group-health-plans-and-health-insurance-issuers-rules-relating-to-internal-claims-and-appeals-and) (2011): Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External Review Processes - [75 FR 70114](https://www.federalregister.gov/documents/2010/11/17/2010-28861/amendment-to-the-interim-final-rules-for-group-health-plans-and-health-insurance-coverage-relating) (2010): Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act - [75 FR 43330](https://www.federalregister.gov/documents/2010/07/23/2010-18043/interim-final-rules-for-group-health-plans-and-health-insurance-issuers-relating-to-internal-claims) (2010): Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act - [75 FR 41726](https://www.federalregister.gov/documents/2010/07/19/2010-17242/interim-final-rules-for-group-health-plans-and-health-insurance-issuers-relating-to-coverage-of) (2010): Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act - [75 FR 37188](https://www.federalregister.gov/documents/2010/06/28/2010-15278/patient-protection-and-affordable-care-act-preexisting-condition-exclusions-lifetime-and-annual) (2010): Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections - [75 FR 34538](https://www.federalregister.gov/documents/2010/06/17/2010-14488/interim-final-rules-for-group-health-plans-and-health-insurance-coverage-relating-to-status-as-a) (2010): Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act - [75 FR 27122](https://www.federalregister.gov/documents/2010/05/13/2010-11391/interim-final-rules-for-group-health-plans-and-health-insurance-issuers-relating-to-dependent) (2010): Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the Patient Protection and Affordable Care Act ## Proposed regulations (not in force) - [Prop. Treas. Reg. § 54.9815-2719T](/26/prop/54.9815-2719T_2013-06454.md): Internal claims and appeals and external review processes. (REG-122706-12, proposed 2013-03-21) - [Prop. Treas. Reg. § 54.9815-2713T](/26/prop/54.9815-2713T_2017-21854.md): [Amended] (REG-129631-17, proposed 2017-10-13) - [Prop. Treas. Reg. § 54.9815-2713](/26/prop/54.9815-2713_2020-24338.md): Coverage of preventive health services. (REG-122462-20, proposed 2020-11-06) - [Prop. Treas. Reg. § 54.9815-2719A](/26/prop/54.9815-2719A_2021-14382.md): Patient protections. (REG-107706-21, proposed 2021-07-13) - [Prop. Treas. Reg. § 54.9815-2719](/26/prop/54.9815-2719_2021-21419.md): Internal claims and appeals and external review processes. (REG-107707-21, proposed 2021-10-07) ## Amendments - 2010-03-23: [Pub. L. 111-148](/26/act/111-148.md), 124 Stat. 270