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Internal Revenue Code, § 9832. Definitions

I.R.C. § 9832(a) Group Health Plan
For purposes of this chapter, the term “group health plan” has the meaning given to such term by section 5000(b)(1).
I.R.C. § 9832(b) Definitions Relating To Health Insurance
For purposes of this chapter—
I.R.C. § 9832(b)(1) Health Insurance Coverage
I.R.C. § 9832(b)(1)(A) In General
Except as provided in subparagraph (B), the term “health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) 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.
I.R.C. § 9832(b)(1)(B) No Application To Certain Excepted Benefits
In applying subparagraph (A), excepted benefits described in subsection (c)(1) shall not be treated as benefits consisting of medical care.
I.R.C. § 9832(b)(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 514(b)(2) of the Employee Retirement Income Security Act of 1974, as in effect on the date of the enactment of this section). Such term does not include a group health plan.
I.R.C. § 9832(b)(3) Health Maintenance Organization
The term “health maintenance organization” means—
I.R.C. § 9832(b)(3)(A)
a Federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act (42 U.S.C. 300e(a))),
I.R.C. § 9832(b)(3)(B)
an organization recognized under State law as a health maintenance organization, or
I.R.C. § 9832(b)(3)(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.
I.R.C. § 9832(c) Excepted Benefits
For purposes of this chapter, the term “excepted benefits” means benefits under one or more (or any combination thereof) of the following:
I.R.C. § 9832(c)(1) Benefits Not Subject To Requirements
I.R.C. § 9832(c)(1)(A)
Coverage only for accident, or disability income insurance, or any combination thereof.
I.R.C. § 9832(c)(1)(B)
Coverage issued as a supplement to liability insurance.
I.R.C. § 9832(c)(1)(C)
Liability insurance, including general liability insurance and automobile liability insurance.
I.R.C. § 9832(c)(1)(D)
Workers' compensation or similar insurance.
I.R.C. § 9832(c)(1)(E)
Automobile medical payment insurance.
I.R.C. § 9832(c)(1)(F)
Credit-only insurance.
I.R.C. § 9832(c)(1)(G)
Coverage for on-site medical clinics.
I.R.C. § 9832(c)(1)(H)
Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
I.R.C. § 9832(c)(2) Benefits Not Subject To Requirements If Offered Separately
I.R.C. § 9832(c)(2)(A)
Limited scope dental or vision benefits.
I.R.C. § 9832(c)(2)(B)
Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
I.R.C. § 9832(c)(2)(C)
Such other similar, limited benefits as are specified in regulations.
I.R.C. § 9832(c)(3) Benefits Not Subject To Requirements If Offered As Independent, Noncoordinated Benefits
I.R.C. § 9832(c)(3)(A)
Coverage only for a specified disease or illness.
I.R.C. § 9832(c)(3)(B)
Hospital indemnity or other fixed indemnity insurance.
I.R.C. § 9832(c)(4) Benefits Not Subject To Requirements If Offered As Separate Insurance Policy
Medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social Security Act), coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code, and similar supplemental coverage provided to coverage under a group health plan.
I.R.C. § 9832(d) Other Definitions
For purposes of this chapter—
I.R.C. § 9832(d)(1) COBRA Continuation Provision
The term “COBRA continuation provision” means any of the following:
I.R.C. § 9832(d)(1)(A)
Section 4980B, other than subsection (f)(1) thereof insofar as it relates to pediatric vaccines.
I.R.C. § 9832(d)(1)(B)
Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.), other than section 609 of such Act.
I.R.C. § 9832(d)(1)(C)
Title XXII of the Public Health Service Act.
I.R.C. § 9832(d)(2) Governmental Plan
The term “governmental plan” has the meaning given such term by section 414(d).
I.R.C. § 9832(d)(3) Medical Care
The term “medical care” has the meaning given such term by section 213(d) determined without regard to—
I.R.C. § 9832(d)(3)(A)
paragraph (1)(C) thereof, and
I.R.C. § 9832(d)(3)(B)
so much of paragraph (1)(D) thereof as relates to qualified long-term care insurance.
I.R.C. § 9832(d)(4) Network Plan
The term “network plan” means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care are provided, in whole or in part, through a defined set of providers under contract with the issuer.
I.R.C. § 9832(d)(5) Placed For Adoption Defined
The term “placement”, or being “placed”, for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child. The child's placement with such person terminates upon the termination of such legal obligation.
I.R.C. § 9832(d)(6) Family Member
The term “family member” means, with respect to any individual—
I.R.C. § 9832(d)(6)(A)
a dependent (as such term is used for purposes of section 9801(f)(2)) of such individual, and
I.R.C. § 9832(d)(6)(B)
any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual or of an individual described in subparagraph (A).
I.R.C. § 9832(d)(7) Genetic Information
I.R.C. § 9832(d)(7)(A) In General
The term “genetic information” means, with respect to any individual, information about—
I.R.C. § 9832(d)(7)(A)(i)
such individual's genetic tests,
I.R.C. § 9832(d)(7)(A)(ii)
the genetic tests of family members of such individual, and
I.R.C. § 9832(d)(7)(A)(iii)
the manifestation of a disease or disorder in family members of such individual.
I.R.C. § 9832(d)(7)(B) Inclusion Of Genetic Services And Participation In Genetic Research
Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.
I.R.C. § 9832(d)(7)(C) Exclusions
The term “genetic information” shall not include information about the sex or age of any individual.
I.R.C. § 9832(d)(8) Genetic Test
I.R.C. § 9832(d)(8)(A) In General
The term “genetic test” means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutations, or chromosomal changes.
I.R.C. § 9832(d)(8)(B) Exceptions
The term “genetic test” does not mean—
I.R.C. § 9832(d)(8)(B)(i)
an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes, or
I.R.C. § 9832(d)(8)(B)(ii)
an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved.
I.R.C. § 9832(d)(9) Genetic Services
The term “genetic services” means
I.R.C. § 9832(d)(9)(A)
a genetic test;
I.R.C. § 9832(d)(9)(B)
genetic counseling (including obtaining, interpreting, or assessing genetic information); or
I.R.C. § 9832(d)(9)(C)
genetic education.
I.R.C. § 9832(d)(10) Underwriting Purposes
The term “underwriting purposes” means, with respect to any group health plan, or health insurance coverage offered in connection with a group health plan—
I.R.C. § 9832(d)(10)(A)
rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the plan or coverage;
I.R.C. § 9832(d)(10)(B)
the computation of premium or contribution amounts under the plan or coverage;
I.R.C. § 9832(d)(10)(C)
the application of any pre-existing condition exclusion under the plan or coverage; and
I.R.C. § 9832(d)(10)(D)
other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.
(Added Pub. L. 104-191, Sec. 401, Aug. 21, 1996, 110 Stat. 1936; Pub. L. 110-233, Sec. 103(d), May 21, 2008, 122 Stat. 233.)
BACKGROUND NOTES
AMENDMENTS
2008 - Subsec. (d). Pub. L. 110-233, Sec. 103(d), amended subsec. (d) by adding paragraphs (6), (7), (8), (9), and (10).
1997 - Pub. L. 105-34, Sec. 1531(a)(2), redesignated Section 9805 as Section 9832.
EFFECTIVE DATE OF 2008 AMENDMENTS
Amendments by Sec. 103(d) of Pub. L. 110-233 effective for group health plans for plan years beginning after the date that is 1 year after the enactment date of this Act [Enacted: May 21, 2008].
Section 103(f)(1) of Pub. L. 110-233 provided that:
“(1) Regulations—The Secretary of the Treasury shall issue final regulations or other guidance not later than 12 months after the date of the enactment of this Act [Enacted: May 21, 2008] to carry out the amendments made by this section.
EFFECTIVE DATE OF 1997 AMENDMENT
Amendment by Sec. 1531(a)(2) 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.”