I.R.C. § 9815(a) General Rule
Except as provided in subsection (b)—
I.R.C. § 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
I.R.C. § 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.
I.R.C. § 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
(as so amended) had not been enacted.
(Added by Pub. L. 111-148, Sec. 1563(f), as redesignated by Sec. 10107(b)(1), Mar. 23, 2010, 124 Stat. 119.)
Effective on March 23, 2010 [Date of enactment].
COVERAGE OF TESTING FOR COVID–19
Section 6001 of Pub. L. 116-127 provided:
“SEC. 6001. COVERAGE OF TESTING FOR COVID–19.
“(a) IN GENERAL.—A group health plan and a health insurance issuer offering
group or individual health insurance coverage (including a grandfathered health plan
(as defined in section 1251(e) of the Patient Protection and Affordable Care Act))
shall provide coverage, and shall not impose any cost sharing (including deductibles,
copayments, and coinsurance) requirements or prior authorization or other medical
management requirements, for the following items and services furnished during any
portion of the emergency period defined in paragraph (1)(B) of section 1135(g) of
the Social Security Act (42 U.S.C. 1320b–5(g)) beginning on or after the date of the enactment of this Act:
“(1) In vitro diagnostic products (as defined in section 809.3(a) of title 21,
Code of Federal Regulations) for the detection of SARS–CoV–2 or the diagnosis
of the virus that causes COVID–19 that are approved, cleared, or authorized
under section 510(k), 513, 515 or 564 of the Federal Food, Drug, and Cosmetic Act,
and the administration of such in vitro diagnostic products.
“(2) Items and services furnished to an individual during health care provider
office visits (which term in this paragraph includes in-person visits and telehealth
visits), urgent care center visits, and emergency room visits that result in an order
for or administration of an in vitro diagnostic product described in paragraph (1),
but only to the extent such items and services relate to the furnishing or administration
of such product or to the evaluation of such individual for purposes of determining
the need of such individual for such product.
“(b) ENFORCEMENT.—The provisions of subsection (a) shall be applied by
the Secretary of Health and Human Services, Secretary of Labor, and Secretary of the
Treasury to group health plans and health insurance issuers offering group or individual
health insurance coverage as if included in the provisions of part A of title XXVII
of the Public Health Service Act, part 7 of the Employee Retirement Income Security
Act of 1974, and subchapter B of chapter 100 of the Internal Revenue Code
of 1986, as applicable.
“(c) IMPLEMENTATION.—The Secretary of Health and Human Services, Secretary
of Labor, and Secretary of the Treasury may implement the provisions of this section
through sub-regulatory guidance, program instruction or otherwise.
“(d) TERMS.—The terms ‘‘group health plan’’; ‘‘health
insurance issuer’’; ‘‘group health insurance coverage’’,
and ‘‘individual health insurance coverage’’ have the meanings
given such terms in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91
), section 733 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b
), and section 9832 of the Internal Revenue Code
of 1986, as applicable.”