Internal Revenue Code, § 9801. Increased Portability Through Limitation On Preexisting Condition Exclusions

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.

Such period shall begin on the enrollment date.

Any such affiliation period shall run concurrently with any waiting period under the plan.

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).

The terms “TAA-eligible individual” and “TAA-related loss of coverage” have the meanings given such terms in section 4980B(f)(5)(C)(iv).

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

include in such statements a description of the effect of this election.

at the time an individual ceases to be covered under the plan or otherwise becomes covered under a COBRA continuation provision,

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

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 period of creditable coverage of the individual under such plan and the coverage under such COBRA continuation provision, and

the waiting period (if any) (and affiliation period, if applicable) imposed with respect to the individual for any coverage under such plan.

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

such entity may charge the requesting plan or issuer for the reasonable cost of disclosing such information.

was under a COBRA continuation provision and the coverage under such provision was exhausted; or

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.

a group health plan makes coverage available with respect to a dependent of an individual,

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

a person becomes such a dependent of the individual through marriage, birth, or adoption or placement for adoption,

the date dependent coverage is made available, or

the date of the marriage, birth, or adoption or placement for adoption (as the case may be) described in subparagraph (A)(iii).

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;

in the case of a dependent's birth, as of the date of such birth; or

in the case of a dependent's adoption or placement for adoption, the date of such adoption or placement for adoption.

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.

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.

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.