I.R.C. § 9801(a) Limitation On Preexisting Condition Exclusion Period; Crediting For Periods Of Previous
Coverage —
Subject to subsection (d), a group health plan may, with respect to a participant or beneficiary, impose a
preexisting condition exclusion only if—
I.R.C. § 9801(a)(1) —
such exclusion relates to a condition
(whether physical or mental), regardless of the cause of the condition, for which
medical advice, diagnosis, care, or treatment was recommended or received within
the 6-month period ending on the enrollment date;
I.R.C. § 9801(a)(2) —
such exclusion extends for a period of not more than 12 months (or 18 months in the
case of a late enrollee)
after the enrollment date; and
I.R.C. § 9801(a)(3) —
the period of any such preexisting condition exclusion is reduced by the length of
the aggregate of the periods of creditable coverage (if any) applicable to the participant
or beneficiary as of the enrollment date.
I.R.C. § 9801(b) Definitions —
For purposes of this section—
I.R.C. § 9801(b)(1) Preexisting Condition Exclusion
I.R.C. § 9801(b)(1)(A) In General —
The term “preexisting condition exclusion”
means, with respect to coverage, a limitation or exclusion of benefits relating to
a condition based on the fact that the condition was present before the date of enrollment
for such coverage, whether or not any medical advice, diagnosis, care, or treatment
was recommended or received before such date.
I.R.C. § 9801(b)(1)(B) Treatment Of Genetic Information —
For purposes of this section, genetic information shall not be treated as a condition
described in subsection (a)(1) in the absence of a diagnosis of the condition related to such information.
I.R.C. § 9801(b)(2) Enrollment Date —
The term “enrollment date” means, with respect to an individual covered under a group
health plan, the date of enrollment of the individual in the plan or, if earlier,
the first day of the waiting period for such enrollment.
I.R.C. § 9801(b)(3) Late Enrollee —
The term “late enrollee” means, with respect to coverage under a group health plan,
a participant or beneficiary who enrolls under the plan other than during—
I.R.C. § 9801(b)(3)(A) —
the first period in which the individual is eligible to enroll under the plan, or
I.R.C. § 9801(b)(3)(B) —
a special enrollment period under subsection (f).
I.R.C. § 9801(b)(4) Waiting Period —
The term “waiting period” means, with respect to a group health plan and an individual
who is a potential participant or beneficiary in the plan, the period that must pass
with respect to the individual before the individual is eligible to be covered for
benefits under the terms of the plan.
I.R.C. § 9801(c) Rules Relating To Crediting Previous Coverage
I.R.C. § 9801(c)(1) Creditable Coverage Defined —
For purposes of this part, the term “creditable coverage” means, with respect to
an individual, coverage of the individual under any of the following:
I.R.C. § 9801(c)(1)(A) —
A group health plan.
I.R.C. § 9801(c)(1)(B) —
Health insurance coverage.
I.R.C. § 9801(c)(1)(C) —
Part A or part B of title XVIII of the Social Security Act.
I.R.C. § 9801(c)(1)(D) —
Title XIX of the Social Security Act, other than coverage consisting solely of benefits
under section 1928.
I.R.C. § 9801(c)(1)(E) —
Chapter 55 of title 10, United States Code.
I.R.C. § 9801(c)(1)(F) —
A medical care program of the Indian Health Service or of a tribal organization.
I.R.C. § 9801(c)(1)(G) —
A State health benefits risk pool.
I.R.C. § 9801(c)(1)(H) —
A health plan offered under chapter 89 of title 5, United States Code.
I.R.C. § 9801(c)(1)(I) —
A public health plan (as defined in regulations).
I.R.C. § 9801(c)(1)(J) —
A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e). Such term does not include coverage consisting solely of coverage of excepted benefits
(as defined in section 9832(c)).
I.R.C. § 9801(c)(2) Not Counting Periods Before Significant Breaks In Coverage
I.R.C. § 9801(c)(2)(A) In General —
A period of creditable coverage shall not be counted, with respect to enrollment
of an individual under a group health plan, if, after such period and before the
enrollment date, there was a 63-day period during all of which the individual was
not covered under any creditable coverage.
I.R.C. § 9801(c)(2)(B) Waiting Period Not Treated As A Break In Coverage —
For purposes of subparagraph (A) and subsection (d)(4), any period that an individual is in a waiting period for any coverage under a group
health plan or is in an affiliation period shall not be taken into account in determining
the continuous period under subparagraph (A).
I.R.C. § 9801(c)(2)(C) Affiliation Period
I.R.C. § 9801(c)(2)(C)(i) In General —
For purposes of this section, the term “affiliation period” means a period which,
under the terms of the health insurance coverage offered by the health maintenance
organization, must expire before the health insurance coverage becomes effective.
During such an affiliation period, the organization is not required to provide health
care services or benefits and no premium shall be charged to the participant or
beneficiary.
I.R.C. § 9801(c)(2)(C)(iii) Runs Concurrently With Waiting Periods —
Any such affiliation period shall run concurrently with any waiting period under
the plan.
I.R.C. § 9801(c)(2)(D) TAA-Eligible Individuals —
In the case of plan years beginning before January 1, 2014—
I.R.C. § 9801(c)(2)(D)(i) TAA Pre-Certification Period Rule —
In the case of a TAA-eligible individual, the period beginning on the date the individual
has a TAA-related loss of coverage and ending on the date which is 7 days after the
date of the issuance by the Secretary (or by any person or entity designated by the
Secretary)
of a qualified health insurance costs credit eligibility certificate for such individual
for purposes of section 7527 shall not be taken into account in determining the continuous period under subparagraph
(A).
I.R.C. § 9801(c)(2)(D)(ii) Definitions —
The terms “TAA-eligible individual” and “TAA-related loss of coverage” have the meanings
given such terms in section 4980B(f)(5)(C)(iv).
I.R.C. § 9801(c)(3) Method Of Crediting Coverage
I.R.C. § 9801(c)(3)(A) Standard Method —
Except as otherwise provided under subparagraph (B), for purposes of applying subsection
(a)(3), a group health plan shall count a period of creditable coverage without regard
to the specific benefits for which coverage is offered during the period.
I.R.C. § 9801(c)(3)(B) Election Of Alternative Method —
A group health plan may elect to apply subsection (a)(3) based on coverage
of any benefits within each of several classes or categories of benefits
specified in regulations rather than as provided under subparagraph (A). Such election shall be made on a uniform basis for all participants and beneficiaries.
Under such election a group health plan shall count a period of creditable coverage
with respect to any class or category of benefits if any level of benefits is covered
within such class or category.
I.R.C. § 9801(c)(3)(C) Plan Notice —
In the case of an election with respect to a group health plan under subparagraph
(B), the plan shall—
I.R.C. § 9801(c)(3)(C)(i) —
prominently state in any disclosure statements concerning the plan, and state to
each enrollee at the time of enrollment under the plan, that the plan has made such
election, and
I.R.C. § 9801(c)(3)(C)(ii) —
include in such statements a description of the effect of this election.
I.R.C. § 9801(c)(4) Establishment Of Period —
Periods of creditable coverage with respect to an individual shall be established
through presentation of certifications described in subsection (e) or in such other manner as may be specified in regulations.
I.R.C. § 9801(d) Exceptions
I.R.C. § 9801(d)(1) Exclusion Not Applicable To Certain Newborns —
Subject to paragraph (4), a group health plan may not impose any preexisting condition exclusion in the case
of an individual who, as of the last day of the 30-day period beginning with the
date of birth, is covered under creditable coverage.
I.R.C. § 9801(d)(2) Exclusion Not Applicable To Certain Adopted Children —
Subject to paragraph (4), a group health plan may not impose any preexisting condition exclusion in the case
of a child who is adopted or placed for adoption before attaining 18 years of age
and who, as of the last day of the 30-day period beginning on the date of the adoption
or placement for adoption, is covered under creditable coverage. The previous sentence
shall not apply to coverage before the date of such adoption or placement for adoption.
I.R.C. § 9801(d)(3) Exclusion Not Applicable To Pregnancy —
For purposes of this section, a group health plan may not impose any preexisting
condition exclusion relating to pregnancy as a preexisting condition.
I.R.C. § 9801(d)(4) Loss If Break In Coverage —
Paragraphs (1) and (2) shall no longer apply to an individual after the end of the first 63-day period
during all of which the individual was not covered under any creditable coverage.
I.R.C. § 9801(e) Certifications And Disclosure Of Coverage
I.R.C. § 9801(e)(1) Requirement For Certification Of Period Of Creditable Coverage
I.R.C. § 9801(e)(1)(A) In General —
A group health plan shall provide the certification described in subparagraph (B)—
I.R.C. § 9801(e)(1)(A)(i) —
at the time an individual ceases to be covered under the plan or otherwise becomes
covered under a COBRA continuation provision,
I.R.C. § 9801(e)(1)(A)(ii) —
in the case of an individual becoming covered under such a provision, at the time
the individual ceases to be covered under such provision, and
I.R.C. § 9801(e)(1)(A)(iii) —
on the request on behalf of an individual made not later than 24 months after the
date of cessation of the coverage described in clause (i) or (ii), whichever is later.
The certification under clause (i) may be provided, to the extent practicable, at a time consistent with notices required
under any applicable COBRA continuation provision.
I.R.C. § 9801(e)(1)(B) Certification —
The certification described in this subparagraph is a written certification of—
I.R.C. § 9801(e)(1)(B)(i) —
the period of creditable coverage of the individual under such plan and the coverage
under such COBRA continuation provision, and
I.R.C. § 9801(e)(1)(B)(ii) —
the waiting period (if any) (and affiliation period, if applicable) imposed with
respect to the individual for any coverage under such plan.
I.R.C. § 9801(e)(1)(C) Issuer Compliance —
To the extent that medical care under a group health plan consists of health insurance
coverage offered in connection with the plan, the plan is deemed to have satisfied
the certification requirement under this paragraph if the issuer provides for such
certification in accordance with this paragraph.
I.R.C. § 9801(e)(2) Disclosure Of Information On Previous Benefits
I.R.C. § 9801(e)(2)(A) In General —
In the case of an election described in subsection (c)(3)(B) by a group
health plan, if the plan enrolls an individual for coverage under the plan and the
individual provides a certification of coverage of the individual under paragraph
(1)—
I.R.C. § 9801(e)(2)(A)(i) —
upon request of such plan, the entity which issued the certification provided by
the individual shall promptly disclose to such requesting plan information on coverage
of classes and categories of health benefits available under such entity's plan,
and
I.R.C. § 9801(e)(2)(A)(ii) —
such entity may charge the requesting plan or issuer for the reasonable cost of
disclosing such information.
I.R.C. § 9801(e)(3) Regulations —
The Secretary shall establish rules to prevent an entity's failure to provide information
under paragraph (1) or (2) with respect to previous coverage of an individual from adversely affecting any
subsequent coverage of the individual under another group health plan or health insurance
coverage.
I.R.C. § 9801(f) Special Enrollment Periods
I.R.C. § 9801(f)(1) Individuals Losing Other Coverage —
A group health plan shall permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan
(or a dependent of such an employee if the dependent is eligible, but not enrolled,
for coverage under such terms) to enroll for coverage under the terms of the plan
if each of the following conditions is met:
I.R.C. § 9801(f)(1)(A) —
The employee or dependent was covered under a group health plan or had health insurance
coverage at the time coverage was previously offered to the employee or individual.
I.R.C. § 9801(f)(1)(B) —
The employee stated in writing at such time that coverage under a group health plan
or health insurance coverage was the reason for declining enrollment, but only if
the plan sponsor (or the health insurance issuer offering health insurance coverage
in connection with the plan) required such a statement at such time and provided
the employee with notice of such requirement
(and the consequences of such requirement) at such time.
I.R.C. § 9801(f)(1)(C) —
The employee's or dependent's coverage described in subparagraph (A)—
I.R.C. § 9801(f)(1)(C)(i) —
was under a COBRA continuation provision and the coverage under such provision was
exhausted; or
I.R.C. § 9801(f)(1)(C)(ii) —
was not under such a provision and either the coverage was terminated as a result
of loss of eligibility for the coverage (including as a result of legal separation,
divorce, death, termination of employment, or reduction in the number of hours of
employment) or employer contributions toward such coverage were terminated.
I.R.C. § 9801(f)(1)(D) —
Under the terms of the plan, the employee requests such enrollment not later than
30 days after the date of exhaustion of coverage described in subparagraph (C)(i) or termination of coverage or employer contribution described in subparagraph (C)(ii).
I.R.C. § 9801(f)(2) For Dependent Beneficiaries
I.R.C. § 9801(f)(2)(A) In General —
If—
I.R.C. § 9801(f)(2)(A)(i) —
a group health plan makes coverage available with respect to a dependent of an individual,
I.R.C. § 9801(f)(2)(A)(ii) —
the individual is a participant under the plan (or has met any waiting period applicable
to becoming a participant under the plan and is eligible to be enrolled under the
plan but for a failure to enroll during a previous enrollment period), and
I.R.C. § 9801(f)(2)(A)(iii) —
a person becomes such a dependent of the individual through marriage, birth, or
adoption or placement for adoption,
the group health plan shall provide
for a dependent special enrollment period described in subparagraph (B) during which the person (or, if not otherwise enrolled, the individual) may be
enrolled under the plan as a dependent of the individual, and in the case of the
birth or adoption of a child, the spouse of the individual
may be enrolled as a dependent of the individual if such spouse is
otherwise eligible for coverage.
I.R.C. § 9801(f)(2)(B) Dependent Special Enrollment Period —
The dependent special enrollment period under this subparagraph shall be a period
of not less than 30 days and shall begin on the later of—
I.R.C. § 9801(f)(2)(B)(i) —
the date dependent coverage is made available, or
I.R.C. § 9801(f)(2)(B)(ii) —
the date of the marriage, birth, or adoption or placement for adoption (as the case
may be) described in subparagraph (A)(iii).
I.R.C. § 9801(f)(2)(C) No Waiting Period —
If an individual seeks coverage of a dependent during the first 30 days of such
a dependent special enrollment period, the coverage of the dependent shall become
effective—
I.R.C. § 9801(f)(2)(C)(i) —
in the case of marriage, not later than the first day of the first month beginning
after the date the completed request for enrollment is received;
I.R.C. § 9801(f)(2)(C)(ii) —
in the case of a dependent's birth, as of the date of such birth; or
I.R.C. § 9801(f)(2)(C)(iii) —
in the case of a dependent's adoption or placement for adoption, the date of such
adoption or placement for adoption.
I.R.C. § 9801(f)(3) Special Rules Relating To Medicaid And CHIP
I.R.C. § 9801(f)(3)(A) In General —
A group health plan shall permit an employee who is eligible, but not enrolled, for
coverage under the terms of the plan (or a dependent of such an employee if the dependent
is eligible, but not enrolled, for coverage under such terms) to enroll for coverage
under the terms of the plan if either of the following conditions is met:
I.R.C. § 9801(f)(3)(A)(i) Termination Of Medicaid Or CHIP Coverage —
The employee or dependent is covered under a Medicaid plan under title XIX of the
Social Security Act or under a State child health plan under title XXI of such Act
and coverage of the employee or dependent under such a plan is terminated as a result
of loss of eligibility for such coverage and the employee requests coverage under
the group health plan not later than 60 days after the date of termination of such
coverage.
I.R.C. § 9801(f)(3)(A)(ii) Eligibility For Employment Assistance Under Medicaid Or CHIP —
The employee or dependent becomes eligible for assistance, with respect to coverage
under the group health plan under such Medicaid plan or State child health plan (including
under any waiver or demonstration project conducted under or in relation to such a
plan), if the employee requests coverage under the group health plan not later than
60 days after the date the employee or dependent is determined to be eligible for
such assistance.
I.R.C. § 9801(f)(3)(B) Employee Outreach And Disclosure
I.R.C. § 9801(f)(3)(B)(i) Outreach To Employees Regarding Availability Of Medicaid And CHIP Coverage
I.R.C. § 9801(f)(3)(B)(i)(I) In General —
Each employer that maintains a group health plan in a State that provides medical
assistance under a State Medicaid plan under title XIX of the Social Security Act,
or child health assistance under a State child health plan under title XXI of such
Act, in the form of premium assistance for the purchase of coverage under a group
health plan, shall provide to each employee a written notice informing the employee
of potential opportunities then currently available
in the State in which the employee resides for premium assistance under such plans
for health coverage of the employee or the employee's dependents. For purposes of
compliance with this clause, the employer may use any State-specific model notice
developed in accordance with section 701(f)(3)(B)(i)(II)
of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(f)(3)(B)(i)(II)).
I.R.C. § 9801(f)(3)(B)(i)(II) Option To Provide Concurrent With Provision Of Plan Materials To Employee —
An employer may provide the model notice applicable to the State in which an employee
resides concurrent with the furnishing of materials notifying the employee of health
plan eligibility, concurrent with materials provided to the employee in connection
with an open season or election process conducted under the plan, or concurrent
with the furnishing of the summary plan description as provided in section 104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1024).
I.R.C. § 9801(f)(3)(B)(ii) Disclosure About Group Health Plan Benefits To States For Medicaid And CHIP Eligible
Individuals —
In the case of a participant or beneficiary of a group health plan who is covered
under a Medicaid plan of a State under title XIX of the Social Security Act or under
a State child health plan under title XXI of such Act, the plan administrator of the
group health plan shall disclose to the State, upon request, information about the
benefits available under the group health plan in sufficient specificity, as determined
under regulations of the Secretary of
Health and Human Services in consultation with the Secretary that require use of the
model coverage coordination disclosure form developed under section 311(b)(1)(C) of the Children's Health Insurance Program Reauthorization Act of 2009, so as to
permit the State to make a determination (under paragraph
(2)(B), (3), or (10) of section 2105(c) of the Social Security Act or otherwise) concerning the cost-effectiveness of the
State providing medical or child health assistance through premium assistance for
the purchase of coverage under such group health plan and in order for the State to
provide supplemental benefits
required under paragraph (10)(E) of such section or other authority.
(Added Pub. L. 104-191, Sec. 401, Aug. 21, 1996, 110 Stat. 1936; Amended Pub. L. 105-34, title XVI, Sec. 1531(b)(1)(A), Aug. 5, 1997, 111 Stat 788; Pub. L. 111-3, title III, Sec. 311(a), Feb. 4, 2009, 123 Stat. 8; Pub. L. 111-5, div. B, title I, Sec. 1899D, Feb. 17, 2009, 123 Stat. 115; Pub. L. 111-344, title I, Sec. 114(a), Dec. 29, 2010, 124 Stat. 3611; Pub. L. 112-40, title II, Sec. 242(a), Oct. 2011, Stat. 401.)
BACKGROUND NOTES
AMENDMENTS
2011 - Subsec. (c)(2)(D). Pub. L. 112-40, Sec. 242(a)(1), amended subpar. (D) by substituting “January 1, 2014”
for “February 13, 2011”.
2010 - Subsec. (c)(2)(D). Pub. L. 111-344, Sec. 114(a), amended subpar. (D) by substituting “February 13, 2011” for “January 1, 2011”.
2009 - Subsec. (c)(2)(D). Pub. L. 111-5, Div. B, Sec. 1899D(a), amended par. (2) by adding subpar. (D).
Subsec. (f)(3). Pub. L. 111-3, Sec. 311(a), amended subsec. (f) by adding par.
(3).
1997 - Subsec. (c)(1). Pub. L. 105-34, Sec. 1531(b)(1)(A), substituted “section 9832(c)” for “section 9805(c)”
in the last sentence.
EFFECTIVE DATE OF 2011 AMENDMENT
Amendment by Sec. 242(a) of Pub. L. 112-40 effective for plan years beginning after February 12, 2011.
Sec. 242(b)(2) of Pub. L. 112-40 provided the following transitional rules:
“(2) TRANSITIONAL RULES.—
“(A) BENEFIT DETERMINATIONS.—Notwithstanding the amendments made by this section (and
the provisions of law amended thereby), a plan shall not be required to modify benefit
determinations for the period beginning on February 13, 2011, and ending 30 days after
the date of the enactment of this Act, but a plan shall not fail to be qualified health
insurance within the meaning of section 35(e) of the Internal Revenue Code of 1986 during this period merely due to such failure to modify benefit determinations.
“(B) GUIDANCE CONCERNING PERIODS BEFORE 30 DAYS AFTER ENACTMENT.—Except as provided
in subparagraph (A), the Secretary of the Treasury (or his designee), in consultation
with the Secretary of Health and Human Services and the Secretary of Labor, may issue
regulations or other guidance regarding the scope of the application of the amendments
made by this section to periods before the date which is 30 days after the date of
the enactment of this Act.
“(C) SPECIAL RULE RELATING TO CERTAIN LOSS OF COVERAGE.—In the case of a TAA-related
loss of coverage (as defined in section 4980B(f)(5)(C)(iv)
of the Internal Revenue Codeof 1986) that occurs during the period beginning on February 13, 2011, and ending
30 days after the date of the enactment of this Act, the 7-day period described in
section 9801(c)(2)(D) of the Internal Revenue Code of 1986, section 701(c)(2)(C) of the Employee Retirement Income Security Act of 1974, and section 2701(c)(2)(C) of the Public Health Service Act shall be extended
until 30 days after such date of enactment.”
EFFECTIVE DATE OF 2010 AMENDMENT
Amendment by Sec. 114(a) of Pub. L. 111-344 effective for plan years beginning after December 31, 2010.
EFFECTIVE DATE OF 2009 AMENDMENT
Amendment by Sec. 1899D(a) of Pub. L. 111-5, Div. B, effective for plan years beginning after the date of the enactment of this
Act [Enacted: Feb. 17, 2009].
Sec. 3 of Pub. L. 111-3 provided that:
“(a) General Effective Date.--Unless otherwise provided in this Act, subject to subsections
(b) through (d), this Act (and the amendments made by this Act) shall take effect
on April 1, 2009, and shall apply to child health assistance and medical assistance
provided on or after that date.
“ (b) Exception for State Legislation.--In the case of a State plan under title XIX
or State child health plan under XXI of the Social Security Act, which the Secretary
of Health and Human Services determines requires State legislation in order for the
respective plan to meet one or more additional requirements imposed by amendments
made by this Act, the respective plan shall not be regarded as failing to comply
with the requirements of such title solely on the basis of its failure to meet such
an additional requirement before the first day of the first calendar quarter beginning
after the close of the first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the previous sentence, in
the case of a State that has a 2-year legislative session, each year of the session
shall be considered to be a separate regular session of the State legislature.
“(c) Coordination of CHIP Funding for Fiscal Year 2009.-- Notwithstanding any other
provision of law, insofar as funds have been appropriated under section 2104(a)(11),
2104(k), or 2104(l) of the Social Security Act, as amended by section 201 of Public Law 110-173, to provide allotments to States under CHIP for fiscal year 2009--
“ (1) any amounts that are so appropriated that are not so allotted and obligated
before April 1, 2009 are rescinded;
and
“(2) any amount provided for CHIP allotments to a State under this Act (and the amendments
made by this Act) for such fiscal year shall be reduced by the amount of such appropriations
so allotted and obligated before such date.
“(d) Reliance on Law.--With respect to amendments made by this Act (other than title
VII) that become effective as of a date--
“ (1) such amendments are effective as of such date whether or not regulations implementing
such amendments have been issued; and
“ (2) Federal financial participation for medical assistance or child health assistance
furnished under title XIX or XXI, respectively, of the Social Security Act on or after
such date by a State in good faith reliance on such amendments before the date of
promulgation of final regulations, if any, to carry out such amendments (or before
the date of guidance, if any, regarding the implementation of such amendments) shall
not be denied on the basis of the State's failure to comply with such regulations
or guidance.”
EFFECTIVE DATE OF 1997 AMENDMENTS
Amendment by Sec. 1531(b)(1)(A) of Pub. L. 105-34 applicable with respect to group health plans for plan years beginning on or after
January 1, 1998.
EFFECTIVE DATE
Effective, except as otherwise noted, for plan years beginning after June 30, 1997.
Section 401(c) of Pub. L. 104-191 provided that:
“(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 chapter 100 of the Internal Revenue Code of 1986 (as added by this section) in determining creditable coverage.
(ii) Special rule for certain periods.--The Secretary of the Treasury, consistent
with section 104, 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 9801 of the Internal Revenue Code of 1986 (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.
(3) Special rule for collective bargaining agreements.-- Except as provided in paragraph
(2), 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], the amendments made by 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 [Aug. 21, 1996]), 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 added by this section shall not be treated as a termination
of such collective bargaining agreement.
(4) Timely regulations.--The Secretary of the Treasury, consistent with section 104,
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.
(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.”