Quiero saber acerca de...

jbell on DSKJLSW7X2PROD with RULES2

Federal Register / Vol. 86, No. 131 / Tuesday, July 13, 2021 / Rules and Regulations with a group health plan. Unless a State elects otherwise in accordance with section 2791e1Bii of the PHS Act, such term also includes coverage offered in connection with a group health plan that has fewer than two participants who are current employees on the first day of the plan year.
Issuer means a health insurance issuer.
Late enrollee means an individual whose enrollment in a plan is a late enrollment.
Late enrollment means enrollment of an individual under a group health plan other than on the earliest date on which coverage can become effective for the individual under the terms of the plan;
or through special enrollment. For rules relating to special enrollment, see 54.98016. If an individual ceases to be eligible for coverage under a plan, and then subsequently becomes eligible for coverage under the plan, only the individuals most recent period of eligibility is taken into account in determining whether the individual is a late enrollee under the plan with respect to the most recent period of coverage.
Similar rules apply if an individual again becomes eligible for coverage following a suspension of coverage that applied generally under the plan.
Medical care has the meaning given such term by section 213d, determined without regard to section 213d1C
and so much of section 213d1D as relates to qualified long-term care insurance.
Medical condition or condition means any condition, whether physical or mental, including, but not limited to, any condition resulting from illness, injury whether or not the injury is accidental, pregnancy, or congenital malformation. However, genetic information is not a condition.
Participant means participant within the meaning of section 37 of ERISA.
Placement, or being placed, for adoption means the assumption and retention of a legal obligation for total or partial support of a child by a person with whom the child has been placed in anticipation of the childs adoption. The childs placement for adoption with such person ends upon the termination of such legal obligation.
Plan year means the year that is designated as the plan year in the plan document of a group health plan, except that if the plan document does not designate a plan year or if there is no plan document, the plan year is 1 The deductible or limit year used under the plan;
2 If the plan does not impose deductibles or limits on a yearly basis, then the plan year is the policy year;

VerDate Sep<11>2014

20:26 Jul 12, 2021

Jkt 253001

3 If the plan does not impose deductibles or limits on a yearly basis, and either the plan is not insured or the insurance policy is not renewed on an annual basis, then the plan year is the employers taxable year; or 4 In any other case, the plan year is the calendar year.
Preexisting condition exclusion means a limitation or exclusion of benefits including a denial of coverage based on the fact that the condition was present before the effective date of coverage or if coverage is denied, the date of the denial under a group health plan or group or individual health insurance coverage or other coverage provided to federally eligible individuals pursuant to 45 CFR part 148, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that day. A preexisting condition exclusion includes any limitation or exclusion of benefits including a denial of coverage applicable to an individual as a result of information relating to an individuals health status before the individuals effective date of coverage or if coverage is denied, the date of the denial under a group health plan, or group or individual health insurance coverage or other coverage provided to federally eligible individuals pursuant to 45 CFR
part 148, such as a condition identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the preenrollment period.
Public health plan means public health plan within the meaning of 54.98014a1ix.
Public Health Service Act PHS Act means the Public Health Service Act 42
U.S.C. 201, et seq..
Short-term, limited-duration insurance means health insurance coverage provided pursuant to a contract with an issuer that:
1 Has an expiration date specified in the contract that is less than 12 months after the original effective date of the contract and, taking into account renewals or extensions, has a duration of no longer than 36 months in total;
2 With respect to policies having a coverage start date before January 1, 2019, displays prominently in the contract and in any application materials provided in connection with enrollment in such coverage in at least 14 point type the language in the following Notice 1, excluding the heading Notice 1, with any additional information required by applicable state law:

PO 00000

Frm 00078

Fmt 4701

Sfmt 4700

36949

Notice 1
This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services. Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage. Also, this coverage is not minimum essential coverage. If you dont have minimum essential coverage for any month in 2018, you may have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month.

3 With respect to policies having a coverage start date on or after January 1, 2019, displays prominently in the contract and in any application materials provided in connection with enrollment in such coverage in at least 14 point type the language in the following Notice 2, excluding the heading Notice 2, with any additional information required by applicable state law:
Notice 2
This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services. Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.

4 If a court holds the 36-month maximum duration provision set forth in paragraph 1 of this definition or its applicability to any person or circumstances invalid, the remaining provisions and their applicability to other people or circumstances shall continue in effect.
Significant break in coverage means a significant break in coverage within the meaning of 54.98014b2iii.
Special enrollment means enrollment in a group health plan under the rights described in 54.98016 or in group health insurance coverage under the rights described in 29 CFR 2590.7016
or 45 CFR 146.117.

E:FRFM13JYR2.SGM

13JYR2