45 C.F.R. Subpart D—Enforcement; Penalties; Preemption
Title 45 - Public Welfare
(a) Scope. (1) This section describes the effect of sections 2741 through 2763 and 2791 of the PHS Act on a State's authority to regulate health insurance issuers in the individual market. This section makes clear that States remain subject to section 514 of ERISA, which generally preempts State law that relates to ERISA-covered plans. (2) Sections 2741 through 2763 and 2791 of the PHS Act cannot be construed to affect or modify the provisions of section 514 of ERISA. (b) Regulation of insurance issuers. The individual market rules of this part do not prevent a State law from establishing, implementing, or continuing in effect standards or requirements unless the standards or requirements prevent the application of a requirement of this part. The requirements of this part do not apply to individual health insurance coverage in relation to its provision of the benefits described in paragraphs (a) and (b) of this section (or any combination of the benefits). (a) Benefits excepted in all circumstances. The following benefits are excepted in all circumstances: (1) Coverage only for accident (including accidental death and dismemberment). (2) Disability income insurance. (3) Liability insurance, including general liability insurance and automobile liability insurance. (4) Coverage issued as a supplement to liability insurance. (5) Workers' compensation or similar insurance. (6) Automobile medical payment insurance. (7) Credit-only insurance (for example, mortgage insurance). (8) Coverage for on-site medical clinics. (b) Other excepted benefits. The requirements of this part do not apply to individual health insurance coverage described in paragraphs (b)(1) through (b)(6) of this section if the benefits are provided under a separate policy, certificate, or contract of insurance. These benefits include the following: (1) Limited scope dental or vision benefits. These benefits are dental or vision benefits that are limited in scope to a narrow range or type of benefits that are generally excluded from benefit packages that combine hospital, medical, and surgical benefits. (2) Long-term care benefits. These benefits are benefits that are either— (i) Subject to State long-term care insurance laws; (ii) For qualified long-term care insurance services, as defined in section 7702B(c)(1) of the Code, or provided under a qualified long-term care insurance contract, as defined in section 7702B(b) of the Code; or (iii) Based on cognitive impairment or a loss of functional capacity that is expected to be chronic. (3) Coverage only for a specified disease or illness (for example, cancer policies), or hospital indemnity or other fixed indemnity insurance (for example, $100/day) if the policies meet the requirements of §146.145(b)(4)(ii)(B) and (b)(4)(ii)(C) of this subchapter regarding noncoordination of benefits. (4) Medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social Security Act. 42 U.S.C. 1395ss, also known as Medigap or MedSupp insurance). (5) Coverage supplemental to the coverage provided under Chapter 55, Title 10 of the United States Code (also known as CHAMPUS supplemental programs). (6) Similar supplemental coverage provided to coverage under a group health plan. [62 FR 16995, Apr. 8, 1997; 62 FR 31696, June 10, 1997]
Title 45: Public Welfare
PART 148—REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET
Subpart D—Enforcement; Penalties; Preemption
§ 148.210 Preemption.
§ 148.220 Excepted benefits.
