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United States Code (Last Updated: May 24, 2014) |
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Title 29. LABOR |
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Chapter 18. EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM |
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SubChapter I. PROTECTION OF EMPLOYEE BENEFIT RIGHTS |
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SubTitle B. Regulatory Provisions |
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Part 6. continuation coverage and additional standards for group health plans |
§ 1167. Definitions and special rules
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For purposes of this part— (1) Group health plan The term “group health plan” means an employee 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 otherwise. Such term shall not include any plan substantially all of the coverage under which is for qualified long-term care services (as defined in section 7702B(c) of title 26).
(2) Covered employee The term “covered employee” means an individual who is (or was) provided coverage under a group health plan by virtue of 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).
(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 employee, or (ii) as the dependent child of the employee. 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. (B) Special rule for terminations and reduced 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 before such qualifying event, is a beneficiary under the plan— (i) as the spouse of the covered employee, (ii) as the dependent child of the employee, or (iii) as the surviving spouse of the covered 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 regulations 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 coverage, and (B) that the applicable notice period provided under section 1166(a)(2) of this title commences with the date of the loss of coverage.
Amendments
1996—Par. (1). Pub. L. 104–191, § 321(d)(2), inserted at end “Such term shall not include any plan substantially 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 Revenue 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 directed 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).
Effective Date Of Amendment
Amendment by section 321(d)(2) of Pub. L. 104–191 applicable to contracts issued after
Amendment by section 421(b)(3) of Pub. L. 104–191 effective
Amendment by section 7862(c)(2)(A) of Pub. L. 101–239 applicable to plan years beginning after
Pub. L. 101–239, title VII, § 7862(c)(6)(B),
Amendment by section 7891(a)(1) of Pub. L. 101–239 effective, 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
Amendment by Pub. L. 100–647 applicable to taxable years beginning after
Pub. L. 99–514, title XVIII, § 1895(d)(9)(B),
Amendment by section 1895(d)(8) of Pub. L. 99–514 effective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Reconciliation 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 otherwise provided, as if included in title X of the Consolidated 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.
Miscellaneous
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