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ERISA § 702 (29 U.S.C. § 1182)

Prohibiting discrimination against individual participants and beneficiaries based on health status
USC 1996 ed., current through 1997-01-06 · superseded Jan 5, 2009 · last amended by Pub. L. 104-191
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(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.
Source credit, amendments & notes

(Pub. L. 93–406, title I, §702, as added Pub. L. 104–191, title I, §101(a), Aug. 21, 1996, 110 Stat. 1945.)

ERISA § 702 (29 U.S.C. § 1182) — Prohibiting discrimination against individual participants and beneficiaries based on health status · USC 1996 ed., current through 1997-01-06 · https://pensionresource.website/EAMain?content=EAMain.Law&id=usc29-1182&asof=1997-01-06 · printed Oct 16, 2026
On this page
  • (a) In eligibility to enroll
  • (b) In premium contributions
Cited by (code & regs)

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Guidance addressing this section

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Also cited in 18 other documents
Department of Labor (EBSA)
Final Rules
  • 85 FR 2292 Jan 15, 2020 — Department of Labor Federal Civil Penalties Inflation Adjustment Act Annual Adjustments for 2020 (a)(1)(F)(b)(1)
  • 84 FR 213 Jan 23, 2019 — Department of Labor Federal Civil Penalties Inflation Adjustment Act Annual Adjustments for 2019 (a)(1)(F)(b)(1)
  • 83 FR 28912 Jun 21, 2018 — Definition of “Employer” Under Section 3(5) of ERISA-Association Health Plans (a)(1)
  • 82 FR 5373 Jan 18, 2017 — Department of Labor Federal Civil Penalties Inflation Adjustment Act Annual Adjustments for 2017 (a)(1)(F)(b)(1)
  • 81 FR 43430 Jul 1, 2016 — Department of Labor Federal Civil Penalties Inflation Adjustment Act Catch-Up Adjustments (a)(1)(F)(b)(1)
Proposed Rules
  • 83 FR 614Proposed Jan 5, 2018 — Definition of “Employer” Under Section 3(5) of ERISA-Association Health Plans Comments due Mar 6, 2018 (a)(1)
Technical Releases
  • TR 1997-02 Jul 1, 1997 — Technical Release 97-02
IRS / Treasury
Proposed Rules
  • 84 FR 51471Proposed Sep 30, 2019 — Application of the Employer Shared Responsibility Provisions and Certain Nondiscrimination Rules to Health Reimbursement Arrangements and Other Account-Based G… Comments due Dec 30, 2019
  • 83 FR 54420Proposed Oct 29, 2018 — Health Reimbursement Arrangements and Other Account-Based Group Health Plans Comments due Dec 28, 2018
  • 79 FR 76931Proposed Dec 23, 2014 — Amendments to Excepted Benefits Comments due Jan 22, 2015
  • 77 FR 70620Proposed Nov 26, 2012 — Incentives for Nondiscriminatory Wellness Programs in Group Health Plans Comments due Jan 25, 2013
Final Rules
  • 84 FR 28888 Jun 20, 2019 — Health Reimbursement Arrangements and Other Account-Based Group Health Plans (a)(1)
  • 80 FR 72192 Nov 18, 2015 — Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protec…
  • 80 FR 13995 Mar 18, 2015 — Amendments to Excepted Benefits
  • 78 FR 33158 Jun 3, 2013 — Incentives for Nondiscriminatory Wellness Programs in Group Health Plans
  • 75 FR 37188 Jun 28, 2010 — Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections
  • 75 FR 27122 May 13, 2010 — Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the Patient Protection and A… (a)
Treasury Decisions
  • T.D. 9744 Dec 7, 2015 — This document contains final regulations concerning Public Health Services Act sections which are incorporated into section 9815 of the Internal Revenue Code b…

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EffectiveThroughSourceAmended by
Jan 6, 1997Jan 4, 2009USC 1996 ed., current through 1997-01-06 run 61Pub. L. 104-191View
Jan 5, 2009currentUSC 2024 ed., current through 2025-01-06 run 1Pub. L. 110-233View · Redline (sign in)
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