§ 1191b. Definitions

(a) Group health plan For purposes of this part— (1) In general The term “group health plan” means an employee welfare benefit plan to the extent that the plan provides medical care (as defined in paragraph (2) and including items and services paid for as medical care) to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. (2) Medical care The term “medical care” means amounts paid for— (A) the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body, (B) amounts paid for transportation primarily for and essential to medical care referred to in subparagraph (A), and (C) amounts paid for insurance covering medical care referred to in subparagraphs (A) and (B). (b) Definitions relating to health insurance For purposes of this part— (1) health insurance coverage The term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer. (2) health insurance issuer The term “health insurance issuer” means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (3)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section of this title). Such term does not include a group health plan. (3) Health maintenance organization The term “health maintenance organization” means— (A) a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act ( U.S.C. )), (B) an organization recognized under State law as a health maintenance organization, or (C) a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization. (4) Group health insurance coverage The term “group health insurance coverage” means, in connection with a group health plan, health insurance coverage offered in connection with such plan. (c) Excepted benefits For purposes of this part, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following: (1) Benefits not subject to requirements (A) Coverage only for accident, or disability income insurance, or any combination thereof. (B) Coverage issued as a supplement to liability insurance. (C) Liability insurance, including general liability insurance and automobile liability insurance. (D) Workers’ compensation or similar insurance. (E) Automobile medical payment insurance. (F) Credit-only insurance. (G) Coverage for on-site medical clinics. (H) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. (2) Benefits not subject to requirements if offered separately (A) Limited scope dental or vision benefits. (B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof. (C) Such other similar, limited benefits as are specified in regulations. (3) Benefits not subject to requirements if offered as independent, noncoordinated benefits (A) Coverage only for a specified disease or illness. (B) Hospital indemnity or other fixed indemnity insurance. (4) Benefits not subject to requirements if offered as separate insurance policy Medicare supplemental health insurance (as defined under section of title ), coverage supplemental to the coverage provided under chapter of title , and similar supplemental coverage provided to coverage under a group health plan. (d) Other definitions For purposes of this part— (1) COBRA continuation provision The term “COBRA continuation provision” means any of the following: (A) Part 6 of this subtitle. (B) Section of title , other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines. (C) Title XXII of the Public Health Service Act [ U.S.C. et seq.]. (2) Health status-related factor The term “health status-related factor” means any of the factors described in section of this title. (3) Network plan The term “network plan” means health insurance coverage offered by a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, in whole or in part, through a defined set of providers under contract with the issuer. (4) Placed for adoption The term “placement”, or being “placed”, for adoption, has the meaning given such term in section of this title.

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