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42 U.S.C. 18021-18024, 18031-18032, 18041-18042, 18044, 18054, 18061, 18063, 18071, 18082, and 26 U.S.C. 36B.
76 FR 77411, Dec. 13, 2011, unless otherwise noted.
78 FR 12866, Feb. 25, 2013, unless otherwise noted.
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(a) An issuer does not provide EHB if its benefit design, or the implementation of its benefit design, discriminates based on an individual's age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions. Beginning on the earlier of January 1, 2023 (the start of the 2023 plan year) or upon renewal of any plan subject to this rule, a non-discriminatory benefit design that provides EHB is one that is clinically-based.
(b) An issuer providing EHB must comply with the requirements of § 156.200(e) of this subchapter; and
(c) Nothing in this section shall be construed to prevent an issuer from appropriately utilizing reasonable medical management techniques.
[78 FR 12866, Feb. 25, 2013, as amended at 87 FR 27390, May 6, 2022]