Health care reform was enacted through 2 laws:

Public Law 111-148 The Patient Protection and Affordable Care Act (HR 3950) and Public Law 111-152 The Health Care and Education Affordability Reconciliation Act of 2010 (HR 4872)

Many of the provisions of the legislation affect and reference “group health plans” in their application. AGU’s research concludes that limited medical products offered on an indemnity basis are exempt by definition from any requirements placed on “group health plans.”

HR 3590 defines “group health plan” under Section 1301(b)(3) by indicating the term has the same meaning as provided in section 2791(a) of the Public Health Service Act.

SEC. 1301. QUALIFIED HEALTH PLAN DEFINED.

2. Terms Relating to Health Plans- In this title:

   (1) HEALTH PLAN-
   (A) IN GENERAL- The term `health plan' means health insurance coverage and a group health plan.
   (B) EXCEPTION FOR SELF-INSURED PLANS AND MEWAS- Except to the extent specifically provided by this title, the term `health plan' shall not include a group health plan or multiple employer welfare arrangement to the extent the plan or arrangement is not subject to State insurance regulation under section 514 of the Employee Retirement Income Security Act of 1974.

   (2) HEALTH INSURANCE COVERAGE AND ISSUER- The terms `health insurance coverage' and `health insurance issuer' have the meanings given such terms by section 2791(b) of the Public Health Service Act.

    (3) GROUP HEALTH PLAN- The term `group health plan' has the meaning given such term by section 2791(a) of the Public Health Service Act.

The relevant section of the Public Health Service Act is Title 42 of the US Code under Chapter 6A, Subchapter XXV, Part C 300gg-91 entitled “Definitions”. This section includes a listing of “excepted benefits” to which the term “group health plan” will not be applicable. This is similar to the definition under ERISA used to exempt indemnity plans from HIPAA and Mental Health Parity requirements.

300gg–91. Definitions

1. Benefits not subject to requirements
   1. Coverage only for accident, or disability income insurance, or any combination thereof.
   2. Coverage issued as a supplement to liability insurance.
   3. Liability insurance, including general liability insurance and automobile liability insurance.
   4. Workers’ compensation or similar insurance.
   5. Automobile medical payment insurance.
   6. Credit-only insurance.
   7. Coverage for on-site medical clinics.
   8. Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
2. Benefits not subject to requirements if offered separately
   1. Limited scope dental or vision benefits.
   2. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
   3. Such other similar, limited benefits as are specified in regulations.
3. Benefits not subject to requirements if offered as independent, noncoordinated benefits
   1. Coverage only for a specified disease or illness.
   2. Hospital indemnity or other fixed indemnity insurance.
4. Benefits not subject to requirements if offered as separate insurance policy Medicare supplemental health insurance (as defined under section 1395ss (g)(1) of this title), coverage supplemental to the coverage provided under chapter 55 of title 10, and similar supplemental coverage provided to coverage under a group health plan.