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NOTES:
Source
(July 1, 1944, ch. 373, title XXVII, § 2701, as added , title I, § 102(a), Aug. 21, 1996, .)
References in Text
The Social Security Act, referred to in subsec. (c)(1)(C), (D), is act Aug. 14, 1935, ch. 531, , as amended. Parts A and B of title XVIII of the Act are classified generally to parts A (§ 1395c et seq.) and B (§ 1395j et seq.) of subchapter
of chapter
of this title. Title XIX of the Act is classified generally to subchapter XIX (§ 1396 et seq.) of chapter
of this title. For complete classification of this Act to the Code, see section
of this title and Tables.
Prior Provisions
A prior section 2701 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see section
of this title.
Effective Date
Section 102(c) of provided that:
“(1) In general.—Except as provided in this subsection, part A of title XXVII of the Public Health Service Act [this part] (as added by subsection (a)) shall apply 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.
“(2) Determination of creditable coverage.—
“(A) Period of coverage.—
“(i) In general.—Subject to clause (ii), no period before July 1, 1996, shall be taken into account under part A of title XXVII of the Public Health Service Act [this part] (as added by this section) in determining creditable coverage.
“(ii) Special rule for certain periods.—The Secretary of Health and Human Services, consistent with section
[set out as a note under section
of this title], shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have such coverage credited but for clause (i) may be given credit for creditable coverage for such periods through the presentation of documents or other means.
“(B) Certifications, etc.—
“(i) In general.—Subject to clauses (ii) and (iii), subsection (e) of section
of the Public Health Service Act [subsec. (e) of this section] (as added by this section) shall apply to events occurring after June 30, 1996.
“(ii) No certification required to be provided before june 1, 1997.—In no case is a certification required to be provided under such subsection before June 1, 1997.
“(iii) Certification only on written request for events occurring before october 1, 1996.—In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided under such subsection unless an individual (with respect to whom the certification is otherwise required to be made) requests such certification in writing.
“(C) Transitional rule.—In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996—
“(i) the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and
“(ii) a group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under the amendments made by this section [enacting this section and sections
,
to
,
to
,
, and
of this title and amending sections
and
of this title].
“(3) Special rule for collective bargaining agreements.—Except as provided in paragraph (2)(B), in the case of a group health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act [Aug. 21, 1996], part A of title XXVII of the Public Health Service Act [this part] (other than section
thereof [subsec. (e) of this section]) shall not apply to plan years beginning before the later of—
“(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or
“(B) July 1, 1997.
For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of such part shall not be treated as a termination of such collective bargaining agreement.
“(4) Timely regulations.—The Secretary of Health and Human Services, consistent with section
[set out as a note under section
of this title], shall first issue by not later than April 1, 1997, such regulations as may be necessary to carry out the amendments made by this section [enacting this section and sections
,
to
,
to
,
, and
of this title and amending sections
and
of this title] and section
[enacting sections
to
and
to
of this title].
“(5) Limitation on actions.—No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before January 1, 1998, or, if later, the date of issuance of regulations referred to in paragraph (4), if the plan or issuer has sought to comply in good faith with such requirements.”
Congressional Findings Relating to Exercise of Commerce Clause Authority; Severability
Section 195 of title I of provided that:
“(a) Findings Relating to Exercise of Commerce Clause Authority.—Congress finds the following in relation to the provisions of this title [enacting this subchapter and sections
to
and
to
of Title
, Labor, amending sections
,
, and
of this title and sections
,
,
,
,
,
, and
of Title
, and enacting provisions set out as notes under this section, section
of this title, and section
of Title
]:
“(1) Provisions in group health plans and health insurance coverage that impose certain preexisting condition exclusions impact the ability of employees to seek employment in interstate commerce, thereby impeding such commerce.
“(2) health insurance coverage is commercial in nature and is in and affects interstate commerce.
“(3) It is a necessary and proper exercise of Congressional authority to impose requirements under this title on group health plans and health insurance coverage (including coverage offered to individuals previously covered under group health plans) in order to promote commerce among the States.
“(4) Congress, however, intends to defer to States, to the maximum extent practicable, in carrying out such requirements with respect to insurers and health maintenance organizations that are subject to State regulation, consistent with the provisions of the employee Retirement Income Security Act of 1974 [ U.S.C. et seq.].
“(b) Severability.—If any provision of this title or the application of such provision to any person or circumstance is held to be unconstitutional, the remainder of this title and the application of the provisions of such to any person or circumstance shall not be affected thereby.”
Health Coverage Availability Studies
Section 191 of title I of provided that:
“(a) Studies.—
“(1) Study on effectiveness of reforms.—The Secretary of Health and Human Services shall provide for a study on the effectiveness of the provisions of this title [enacting this subchapter and sections
to
and
to
of Title
, Labor, amending sections
,
, and
of this title and sections
,
,
,
,
,
, and
of Title
, and enacting provisions set out as notes under this section, section
of this title, and section
of Title
] and the various State laws, in ensuring the availability of reasonably priced health coverage to employers purchasing group coverage and individuals purchasing coverage on a non-group basis.
“(2) Study on access and choice.—The Secretary also shall provide for a study on—
“(A) the extent to which patients have direct access to, and choice of, health care providers, including specialty providers, within a network plan, as well as the opportunity to utilize providers outside of the network plan, under the various types of coverage offered under the provisions of this title; and
“(B) the cost and cost-effectiveness to health insurance issuers of providing access to out-of-network providers, and the potential impact of providing such access on the cost and quality of health insurance coverage offered under provisions of this title.
“(3) Consultation.—The studies under this subsection shall be conducted in consultation with the Secretary of Labor, representatives of State officials, consumers, and other representatives of individuals and entities that have expertise in health insurance and employee benefits.
“(b) Reports.—Not later than January 1, 2000, the Secretary shall submit to the appropriate committees of Congress a report on each of the studies under subsection (a).”
Section Referred to in Other Sections
This section is referred to in sections
,
,
,
,
,
,
,
,
,
,
of this title; title
section
; title
section
.
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