PUBLIC LAW 104-191—AUG. 21, 1996
110 STAT. 2079
"(2) No APPLICATION TO BENEFITS OR EXCLUSIONS.— To the
extent consistent with section 9801, paragraph (1) shall not
be construed—
"(A) to require a group health plan to provide particular
benefits (or benefits with respect to a specific procedure,
treatment, or service) other than those provided under
the terms of such plan; or
"(B) to prevent such a plan 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 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
factor described in subsection (a)(1) 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 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.
"SEC. 9803. GUARANTEED RENEWABILITY IN MULTIEMPLOYER PLANS
AND CERTAIN MULTIPLE EMPLOYER WELFARE
ARRANGEMENTS.
"(a) IN GENERAL,—^A group health plan which is a multiemployer plan (as defined in section 414(f)) or which is a multiple
employer welfare arrangement may not deny an employer continued
access to the same or different coverage under such plan, other
than—
"(1) for nonpayment of contributions;
"(2) for fraud or other intentional misrepresentation of
material fact by the employer;
"(3) for noncompliance with material plan provisions;
"(4) because the plan is ceasing to offer any coverage in
a geographic area;
"(5) in the case of a plan that offers benefits through
a network plan, because there is no longer any individual
enrolled through the employer who lives, resides, or works
in the service area of the network plan and the plan applies
this paragraph uniformly without regard to the claims experience of employers or a factor described in section 9802(a)(1)
in relation to such individuals or their dependents; or
"(6) for failure to meet the terms of an applicable collective
bargaining agreement, to renew a collective bargaining or other
�
