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Federal Register / Vol. 86, No. 131 / Tuesday, July 13, 2021 / Rules and Regulations
discrimination based on a health factor, as amended by the Patient Protection and Affordable Care Act Affordable Care Act. Other consumer protection provisions, including other protections provided by the Affordable Care Act, the Mental Health Parity and Addiction Equity Act, and the No Surprises Act are set forth in this part.
c Similar requirements under the Employee Retirement Income Security Act and the Public Health Service Act.
Sections 701, 702, 703, 711, 712, 716, 717, 732, and 733 of the Employee Retirement Income Security Act of 1974
and sections 2701, 2702, 2704, 2705, 2721, 2791, 2799A1, and 2799A2 of the Public Health Service Act impose requirements similar to those imposed under Chapter 100 of Subtitle K with respect to health insurance issuers offering group health insurance coverage. See 29 CFR part 2590 and 45
CFR parts 144, 146, 148, and 149. See also part B of Title XXVII of the Public Health Service Act and 45 CFR parts 148 and 149 for other rules applicable to health insurance offered in the individual market defined in 54.98012.
Par. 6. Section 54.98012T is added to read as follows:

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54.98012T

Definitions temporary.

Unless otherwise provided, the definitions in this section and 54.98012 govern in applying the provisions of sections 9801 through 9825 and 9831 through 9834.
Affiliation period means a period of time that must expire before health insurance coverage provided by an HMO becomes effective, and during which the HMO is not required to provide benefits.
COBRA definitions:
1 COBRA means title X of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended.
2 COBRA continuation coverage means coverage, under a group health plan, that satisfies an applicable COBRA
continuation provision.
3 COBRA continuation provision means section 4980B other than paragraph f1 of section 4980B insofar as it relates to pediatric vaccines, sections 601608 of ERISA, or title XXII
of the PHS Act.
4 Exhaustion of COBRA
continuation coverage means that an individuals COBRA continuation coverage ceases for any reason other than either failure of the individual to pay premiums on a timely basis, or for cause such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan. An
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individual is considered to have exhausted COBRA continuation coverage if such coverage ceases i Due to the failure of the employer or other responsible entity to remit premiums on a timely basis;
ii When the individual no longer resides, lives, or works in the service area of an HMO or similar program whether or not within the choice of the individual and there is no other COBRA continuation coverage available to the individual; or iii When the individual incurs a claim that would meet or exceed a lifetime limit on all benefits and there is no other COBRA continuation coverage available to the individual.
Condition means a medical condition.
Creditable coverage means creditable coverage within the meaning of 54.98014a.
Dependent means any individual who is or may become eligible for coverage under the terms of a group health plan because of a relationship to a participant.
Employee Retirement Income Security Act of 1974 ERISA means the Employee Retirement Income Security Act of 1974, as amended 29 U.S.C. 1001
et seq..
Enroll means to become covered for benefits under a group health plan that is, when coverage becomes effective, without regard to when the individual may have completed or filed any forms that are required in order to become covered under the plan. For this purpose, an individual who has health coverage under a group health plan is enrolled in the plan regardless of whether the individual elects coverage, the individual is a dependent who becomes covered as a result of an election by a participant, or the individual becomes covered without an election.
Enrollment date means the first day of coverage or, if there is a waiting period, the first day of the waiting period. If an individual receiving benefits under a group health plan changes benefit packages, or if the plan changes group health insurance issuers, the individuals enrollment date does not change.
Excepted benefits means the benefits described as excepted in 54.9831c.
First day of coverage means, in the case of an individual covered for benefits under a group health plan, the first day of coverage under the plan and, in the case of an individual covered by health insurance coverage in the individual market, the first day of coverage under the policy or contract.
Genetic information has the meaning given the term in 54.98023Ta3.

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Group health insurance coverage means health insurance coverage offered in connection with a group health plan.
Individual health insurance coverage reimbursed by the arrangements described in 29 CFR 2510.31l is not offered in connection with a group health plan, and is not group health insurance coverage, provided all the conditions in 29 CFR 2510.31l are satisfied.
Group health plan or plan means a group health plan within the meaning of 54.98311a.
Group market means the market for health insurance coverage offered in connection with a group health plan.
However, certain very small plans may be treated as being in the individual market, rather than the group market;
see the definition of individual market in this section.
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 HMO contract offered by a health insurance issuer. Health insurance coverage includes group health insurance coverage, individual health insurance coverage, and shortterm, limited-duration insurance.
However, benefits described in 54.9831c2 are not treated as benefits consisting of medical care.
Health insurance issuer or issuer means an insurance company, insurance service, or insurance organization including an HMO that is required to be licensed to engage in the business of insurance in a State and that is subject to State law that regulates insurance within the meaning of section 514b2
of ERISA. Such term does not include a group health plan.
Health maintenance organization or HMO means 1 A federally qualified health maintenance organization as defined in section 1301a of the PHS Act;
2 An organization recognized under State law as a health maintenance organization; or 3 A similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization.
Individual health insurance coverage means health insurance coverage offered to individuals in the individual market, but does not include short-term, limited-duration insurance. Individual health insurance coverage can include dependent coverage.
Individual market means the market for health insurance coverage offered to individuals other than in connection
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