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U.S. Code as of:
01/19/04
Section 1182. Prohibiting discrimination against individual participants and beneficiaries based on health status
(a) In eligibility to enroll
(1) In general
Subject to paragraph (2), a group health plan, and a health
insurance issuer offering group health insurance coverage in
connection with a group health plan, may not establish rules for
eligibility (including continued eligibility) of any individual
to enroll under the terms of the plan based on any of the
following health status-related factors in relation to the
individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both physical and mental
illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including conditions arising
out of acts of domestic violence).
(H) Disability.
(2) No application to benefits or exclusions
To the extent consistent with section 1181 of this title,
paragraph (1) shall not be construed -
(A) to require a group health plan, or group health insurance
coverage, to provide particular benefits other than those
provided under the terms of such plan or coverage, or
(B) to prevent such a plan or coverage from establishing
limitations or restrictions on the amount, level, extent, or
nature of the benefits or coverage for similarly situated
individuals enrolled in the plan or coverage.
(3) Construction
For purposes of paragraph (1), rules for eligibility to enroll
under a plan include rules defining any applicable waiting
periods for such enrollment.
(b) In premium contributions
(1) In general
A group health plan, and a health insurance issuer offering
health insurance coverage in connection with a group health plan,
may not require any individual (as a condition of enrollment or
continued enrollment under the plan) to pay a premium or
contribution which is greater than such premium or contribution
for a similarly situated individual enrolled in the plan on the
basis of any health status-related factor in relation to the
individual or to an individual enrolled under the plan as a
dependent of the individual.
(2) Construction
Nothing in paragraph (1) shall be construed -
(A) to restrict the amount that an employer may be charged
for coverage under a group health plan; or
(B) to prevent a group health plan, and a health insurance
issuer offering group health insurance coverage, from
establishing premium discounts or rebates or modifying
otherwise applicable copayments or deductibles in return for
adherence to programs of health promotion and disease
prevention.
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