29 U.S.C. § 1167 — Definitions and special rules

Page 564 TITLE 29—LABOR § 1167 fied beneficiary as the spouse of the covered em- ployee shall be treated as notification to all other qualified beneficiaries residing with such spouse at the time such notification is made. (Pub. L. 93–406, title I, § 606, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 230; amended Pub. L. 99–509, title IX, § 9501(d)(2), Oct. 21, 1986, 100 Stat. 2077; Pub. L. 99–514, title XVIII, § 1895(d)(6)(B), Oct. 22, 1986, 100 Stat. 2939; Pub. L. 101–239, title VI, § 6703(c), title VII, § 7891(d)(1)(A), Dec. 19, 1989, 103 Stat. 2296, 2445; Pub. L. 104–191, title IV, § 421(b)(2), Aug. 21, 1996, 110 Stat. 2088.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsec. (a)(3), is act Aug. 14, 1935, ch. 531, 49 Stat. 620, as amended. Ti- tles II and XVI of the Social Security Act are classified generally to subchapters II (§ 401 et seq.) and XVI (§ 1381 et seq.), respectively, of chapter 7 of Title 42, The Pub- lic Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Ta- bles. AMENDMENTS 1996—Subsec. (a)(3). Pub. L. 104–191 substituted ‘‘at any time during the first 60 days of continuation cov- erage under this part’’ for ‘‘at the time of a qualifying event described in section 1163(2) of this title’’. 1989—Pub. L. 101–239, § 7891(d)(1)(A)(ii), designated first sentence as subsec. (a), added subsec. (b), des- ignated second sentence as subsec. (c), and substituted ‘‘For purposes of subsection (a)(4)’’ for ‘‘For purposes of paragraph (4)’’. Pub. L. 101–239, § 7891(d)(1)(A)(i)(II), inserted in last sentence ‘‘(or, in the case of a group health plan which is a multiemployer plan, such longer period of time as may be provided in the terms of the plan)’’ after ‘‘14 days’’. Pub. L. 101–239, § 7891(d)(1)(A)(i)(I), inserted ‘‘(or, in the case of a group health plan which is a multiem- ployer plan, such longer period of time as may be pro- vided in the terms of the plan)’’ after ‘‘30 days’’ in par. (2). Pub. L. 101–239, § 6703(c), inserted ‘‘and each qualified beneficiary who is determined, under title II or XVI of the Social Security Act, to have been disabled at the time of a qualifying event described in section 1163(2) of this title is responsible for notifying the plan adminis- trator of such determination within 60 days after the date of the determination and for notifying the plan ad- ministrator within 30 days after the date of any final determination under such title or titles that the quali- fied beneficiary is no longer disabled’’ before comma in par. (3). 1986—Par. (2). Pub. L. 99–509 substituted ‘‘(4), or (6)’’ for ‘‘or (4)’’. Par. (3). Pub. L. 99–514 inserted ‘‘within 60 days after the date of the qualifying event’’. Par. (4)(A). Pub. L. 99–509 substituted ‘‘(4), or (6)’’ for ‘‘or (4)’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1996 AMENDMENT Amendment by Pub. L. 104–191 effective Jan. 1, 1997, regardless of whether qualifying event occurred before, on, or after such date, see section 421(d) of Pub. L. 104–191 set out as a note under section 4980B of Title 26, Internal Revenue Code. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by section 6703(c) of Pub. L. 101–239 appli- cable to plan years beginning on or after Dec. 19, 1989, regardless of whether the qualifying event occurred be- fore, on, or after such date, see section 6703(d) of Pub. L. 101–239, set out as a note under section 1162 of this title. Amendment by section 7891(d)(1)(A) of Pub. L. 101–239 applicable with respect to plan years beginning on or after Jan. 1, 1990, see section 7891(d)(1)(C) of Pub. L. 101–239, set out as a note under section 4980B of Title 26, Internal Revenue Code. EFFECTIVE DATE OF 1986 AMENDMENTS Amendment by Pub. L. 99–514 applicable only with re- spect to qualifying events occurring after Oct. 22, 1986, see section 1895(d)(6)(D) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Revenue Code. Amendment by Pub. L. 99–509 effective, except as oth- erwise provided, as if included in title X of the Consoli- dated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 9501(e) of Pub. L. 99–509, set out as a note under section 162 of Title 26. PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1989 For provisions directing that if any amendments made by subtitle A or subtitle C of title XI [§§ 1101–1147 and 1171–1177] or title XVIII [§§ 1800–1899A] of Pub. L. 99–514 require an amendment to any plan, such plan amendment shall not be required to be made before the first plan year beginning on or after Jan. 1, 1989, see section 1140 of Pub. L. 99–514, as amended, set out as a note under section 401 of Title 26, Internal Revenue Code. NOTIFICATION TO COVERED EMPLOYEES Pub. L. 99–272, title X, § 10002(e), Apr. 7, 1986, 100 Stat. 232, provided that: ‘‘At the time that the amendments made by this section [enacting this part and amending section 1132 of this title] apply to a group health plan (within the meaning of section 607(1) of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1167(1)]), the plan shall notify each covered employee, and spouse of the employee (if any), who is covered under the plan at that time of the continuation cov- erage required under part 6 of subtitle B of title I of such Act [this part]. The notice furnished under this subsection is in lieu of notice that may otherwise be re- quired under section 606(1) of such Act [29 U.S.C. 1166(1)] with respect to such individuals.’’ § 1167. Definitions and special rules For purposes of this part— (1) Group health plan The term ‘‘group health plan’’ means an em- ployee welfare benefit plan providing medical care (as defined in section 213(d) of title 26) to participants or beneficiaries directly or through insurance, reimbursement, or other- wise. Such term shall not include any plan substantially all of the coverage under which is for qualified long-term care services (as de- fined in section 7702B(c) of title 26). Such term shall not include any qualified small employer health reimbursement arrangement (as de- fined in section 9831(d)(2) of title 26). (2) Covered employee The term ‘‘covered employee’’ means an in- dividual who is (or was) provided coverage under a group health plan by virtue of the per- formance of services by the individual for 1 or more persons maintaining the plan (including as an employee defined in section 401(c)(1) of title 26). Page 565 TITLE 29—LABOR § 1167 (3) Qualified beneficiary (A) In general The term ‘‘qualified beneficiary’’ means, with respect to a covered employee under a group health plan, any other individual who, on the day before the qualifying event for that employee, is a beneficiary under the plan— (i) as the spouse of the covered em- ployee, or (ii) as the dependent child of the em- ployee. Such term shall also include a child who is born to or placed for adoption with the cov- ered employee during the period of continu- ation coverage under this part. (B) Special rule for terminations and re- duced employment In the case of a qualifying event described in section 1163(2) of this title, the term ‘‘qualified beneficiary’’ includes the covered employee. (C) Special rule for retirees and widows In the case of a qualifying event described in section 1163(6) of this title, the term ‘‘qualified beneficiary’’ includes a covered employee who had retired on or before the date of substantial elimination of coverage and any other individual who, on the day be- fore such qualifying event, is a beneficiary under the plan— (i) as the spouse of the covered em- ployee, (ii) as the dependent child of the em- ployee, or (iii) as the surviving spouse of the cov- ered employee. (4) Employer Subsection (n) (relating to leased employees) and subsection (t) (relating to application of controlled group rules to certain employee benefits) of section 414 of title 26 shall apply for purposes of this part in the same manner and to the same extent as such subsections apply for purposes of section 106 of title 26. Any regulations prescribed by the Secretary pursuant to the preceding sentence shall be consistent and coextensive with any regula- tions prescribed for similar purposes by the Secretary of the Treasury (or such Secretary’s delegate) under such subsections. (5) Optional extension of required periods A group health plan shall not be treated as failing to meet the requirements of this part solely because the plan provides both— (A) that the period of extended coverage referred to in section 1162(2) of this title commences with the date of the loss of cov- erage, and (B) that the applicable notice period pro- vided under section 1166(a)(2) of this title commences with the date of the loss of cov- erage. (Pub. L. 93–406, title I, § 607, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 231; amended Pub. L. 99–509, title IX, § 9501(c)(2), Oct. 21, 1986, 100 Stat. 2077; Pub. L. 99–514, title XVIII, § 1895(d)(8), (9)(A), Oct. 22, 1986, 100 Stat. 2940; Pub. L. 100–647, title III, § 3011(b)(6), Nov. 10, 1988, 102 Stat. 3625; Pub. L. 101–239, title VII, §§ 7862(c)(2)(A), (6)(A), 7891(a)(1), (d)(2)(B)(i), Dec. 19, 1989, 103 Stat. 2432, 2433, 2445, 2446; Pub. L. 104–191, title III, § 321(d)(2), title IV, § 421(b)(3), Aug. 21, 1996, 110 Stat. 2058, 2088; Pub. L. 114–255, div. C, title XVIII, § 18001(b)(2), Dec. 13, 2016, 130 Stat. 1344.) Editorial Notes AMENDMENTS 2016—Par. (1). Pub. L. 114–255 inserted at end ‘‘Such term shall not include any qualified small employer health reimbursement arrangement (as defined in sec- tion 9831(d)(2) of title 26).’’ 1996—Par. (1). Pub. L. 104–191, § 321(d)(2), inserted at end ‘‘Such term shall not include any plan substan- tially all of the coverage under which is for qualified long-term care services (as defined in section 7702B(c) of title 26).’’ Par. (3)(A). Pub. L. 104–191, § 421(b)(3), inserted at end ‘‘Such term shall also include a child who is born to or placed for adoption with the covered employee during the period of continuation coverage under this part.’’ 1989—Pub. L. 101–239, § 7891(d)(2)(B)(i)(I), inserted ‘‘and special rules’’ after ‘‘Definitions’’ in section catchline. Par. (1). Pub. L. 101–239, § 7862(c)(6)(A), repealed Pub. L. 100–647, § 3011(b)(6), see 1988 Amendment note below. Pub. L. 101–239, § 7891(a)(1), substituted ‘‘Internal Rev- enue Code of 1986’’ for ‘‘Internal Revenue Code of 1954’’, which for purposes of codification was translated as ‘‘title 26’’ thus requiring no change in text. Par. (2). Pub. L. 101–239, § 7862(c)(2)(A), substituted ‘‘the performance of services by the individual for 1 or more persons maintaining the plan (including as an employee defined in section 401(c)(1) of title 26)’’ for ‘‘the individual’s employment or previous employment with an employer’’. Par. (5). Pub. L. 101–239, § 7891(d)(2)(B)(i)(II), added par. (5). 1988—Par. (1). Pub. L. 100–647, § 3011(b)(6), which di- rected amendment of par. (1) by substituting ‘‘section 162(i)(2) of title 26’’ for ‘‘section 162(i)(3) of title 26’’, was repealed by Pub. L. 101–239, § 7862(c)(6)(A). Pub. L. 99–514, § 1895(d)(8), amended par. (1) generally. Prior to amendment, par. (1) read as follows: ‘‘The term ‘group health plan’ means an employee welfare benefit plan that is a group health plan (within the meaning of section 162(i)(3) of title 26).’’ Par. (3)(C). Pub. L. 99–509 added subpar. (C). Par. (4). Pub. L. 99–514, § 1895(d)(9)(A), added par. (4). Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2016 AMENDMENT Pub. L. 114–255, div. C, title XVIII, § 18001(b)(3), Dec. 13, 2016, 130 Stat. 1344, provided that: ‘‘The amendments made by this subsection [amending this section and section 1191b of this title] shall apply to plan years be- ginning after December 31, 2016.’’ EFFECTIVE DATE OF 1996 AMENDMENT Amendment by section 321(d)(2) of Pub. L. 104–191 ap- plicable to contracts issued after Dec. 31, 1996, see sec- tion 321(f) of Pub. L. 104–191, set out as an Effective Date note under section 7702B of Title 26, Internal Rev- enue Code. Amendment by section 421(b)(3) of Pub. L. 104–191 ef- fective Jan. 1, 1997, regardless of whether qualifying event occurred before, on, or after such date, see sec- tion 421(d) of Pub. L. 104–191 set out as a note under sec- tion 4980B of Title 26. EFFECTIVE DATE OF 1989 AMENDMENT Amendment by section 7862(c)(2)(A) of Pub. L. 101–239 applicable to plan years beginning after Dec. 31, 1989, Page 566 TITLE 29—LABOR § 1168 1 So in original. Probably should be section ‘‘13623’’. see section 7862(c)(2)(C) of Pub. L. 101–239, set out as a note under section 4980B of Title 26, Internal Revenue Code. Pub. L. 101–239, title VII, § 7862(c)(6)(B), Dec. 19, 1989, 103 Stat. 2433, provided that: ‘‘Subparagraph (A) [re- pealing section 3011(b)(6) of Pub. L. 100–647, which amended this section] shall be effective as if included in the enactment of section 3011(b) of the Technical and Miscellaneous Revenue Act of 1988 [Pub. L. 100–647].’’ Amendment by section 7891(a)(1) of Pub. L. 101–239 ef- fective, except as otherwise provided, as if included in the provision of the Tax Reform Act of 1986, Pub. L. 99–514, to which such amendment relates, see section 7891(f) of Pub. L. 101–239, set out as a note under section 1002 of this title. Amendment by section 7891(d)(2)(B)(i) of Pub. L. 101–239 applicable with respect to plan years beginning on or after Jan. 1, 1990, see section 7891(d)(2)(C) of Pub. L. 101–239, set out as a note under section 4980B of Title 26, Internal Revenue Code. EFFECTIVE DATE OF 1988 AMENDMENT Amendment by Pub. L. 100–647 applicable to taxable years beginning after Dec. 31, 1988, but not applicable to any plan for any plan year to which section 162(k) of Title 26, Internal Revenue Code (as in effect on the day before Nov. 10, 1988) did not apply by reason of section 10001(e)(2) of Pub. L. 99–272, see section 3011(d) of Pub. L. 100–647, set out as a note under section 162 of Title 26. EFFECTIVE DATE OF 1986 AMENDMENTS Pub. L. 99–514, title XVIII, § 1895(d)(9)(B), Oct. 22, 1986, 100 Stat. 2940, provided that: ‘‘The amendment made by subparagraph (A) [amending this section] shall take ef- fect in the same manner and to the same extent as the amendments made by subsections (e) and (i) of section 1151 of this Act [amending sections 132 and 414 of Title 26, Internal Revenue Code, see section 1151(k) of Pub. L. 99–514, set out as an Effective Date note under section 89 of Title 26].’’ Amendment by section 1895(d)(8) of Pub. L. 99–514 ef- fective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Rec- onciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26. Amendment by Pub. L. 99–509 effective, except as oth- erwise provided, as if included in title X of the Consoli- dated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 9501(e) of Pub. L. 99–509, set out as a note under section 162 of Title 26. PLAN AMENDMENTS NOT REQUIRED UNTIL JANUARY 1, 1989 For provisions directing that if any amendments made by subtitle A or subtitle C of title XI [§§ 1101–1147 and 1171–1177] or title XVIII [§§ 1800–1899A] of Pub. L. 99–514 require an amendment to any plan, such plan amendment shall not be required to be made before the first plan year beginning on or after Jan. 1, 1989, see section 1140 of Pub. L. 99–514, as amended, set out as a note under section 401 of Title 26, Internal Revenue Code. § 1168. Regulations The Secretary may prescribe regulations to carry out the provisions of this part. (Pub. L. 93–406, title I, § 608, as added Pub. L. 99–272, title X, § 10002(a), Apr. 7, 1986, 100 Stat. 231.) § 1169. Additional standards for group health plans (a) Group health plan coverage pursuant to med- ical child support orders (1) In general Each group health plan shall provide bene- fits in accordance with the applicable require- ments of any qualified medical child support order. A qualified medical child support order with respect to any participant or beneficiary shall be deemed to apply to each group health plan which has received such order, from which the participant or beneficiary is eligible to receive benefits, and with respect to which the requirements of paragraph (4) are met. (2) Definitions For purposes of this subsection— (A) Qualified medical child support order The term ‘‘qualified medical child support order’’ means a medical child support order— (i) which creates or recognizes the exist- ence of an alternate recipient’s right to, or assigns to an alternate recipient the right to, receive benefits for which a participant or beneficiary is eligible under a group health plan, and (ii) with respect to which the require- ments of paragraphs (3) and (4) are met. (B) Medical child support order The term ‘‘medical child support order’’ means any judgment, decree, or order (in- cluding approval of a settlement agreement) which— (i) provides for child support with re- spect to a child of a participant under a group health plan or provides for health benefit coverage to such a child, is made pursuant to a State domestic relations law (including a community property law), and relates to benefits under such plan, or (ii) is made pursuant to a law relating to medical child support described in section 1908 of the Social Security Act [42 U.S.C. 1396g–1] (as added by section 13822 1 of the Omnibus Budget Reconciliation Act of 1993) with respect to a group health plan, if such judgment, decree, or order (I) is issued by a court of competent jurisdiction or (II) is issued through an administrative process established under State law and has the force and effect of law under applicable State law. For purposes of this subpara- graph, an administrative notice which is issued pursuant to an administrative process referred to in subclause (II) of the preceding sentence and which has the effect of an order described in clause (i) or (ii) of the preceding sentence shall be treated as such an order. (C) Alternate recipient The term ‘‘alternate recipient’’ means any child of a participant who is recognized under a medical child support order as hav- ing a right to enrollment under a group health plan with respect to such participant.